Kyphosis is an increase in the normal forward curve of the thoracic spine, so the upper back looks rounded, the shoulders are pushed forward and the head sits ahead of the body. The thoracic spine is normally curved, and we speak of abnormal kyphosis when the angle measured on a standing side-view X-ray exceeds the normal range, or when the curve becomes rigid and no longer corrects when the person straightens up. The causes differ and so does the treatment. Postural kyphosis in adolescents is flexible and corrects on active extension; it reflects muscular weakness and study or seating habits and responds to an exercise programme and changes to the desk and chair. Scheuermann's disease is a structural kyphosis in which the vertebral bodies become wedge-shaped; it is stiffer, may be painful during growth, and needs targeted physiotherapy with bracing in selected cases. In older adults kyphosis is often the result of compression fractures on a background of osteoporosis, which makes osteoporosis treatment and fall prevention the core of the plan rather than an add-on. Less common causes include congenital deformity and curves following infection or previous surgery. The limits of treatment should be stated plainly. Exercise improves flexible posture, strength and pain, but it does not reshape vertebrae that have changed shape. Commercial posture braces act as a reminder to straighten up; they do not rebuild a vertebra. In older adults, kyphosis caused by fractures is not corrected by exercise alone, and no medication straightens a spine. Corrective surgery is considered for severe, progressing, disablingly painful kyphosis or when there is nerve compression, and it is a major operation whose benefit is weighed carefully against its risks. One common assumption needs correcting: not all kyphosis comes from sitting badly. Scheuermann's disease and osteoporotic fractures are structural changes that do not arise from posture, and attributing every case to posture delays diagnosis and misses timely treatment, above all the osteoporosis treatment that prevents further fractures. Which treatment suits you is determined by clinical examination, including a flexibility test and neurological check, together with appropriate imaging and bone density assessment when indicated, not by reading a page or comparing photographs.
Procedure steps
- 1
Clinical examination and flexibility testing
The doctor assesses the shape of the back from the side, asks you to straighten up and to bend forward to see whether the curve is flexible or structurally rigid, checks power, sensation and reflexes, and asks about pain and its site, about growth in the young and about height loss in older adults.
- 2
Imaging and angle measurement
A standing lateral X-ray measures the kyphotic angle and shows the shape of the vertebral bodies and any fractures. MRI may be requested for severe pain or neurological signs, and bone density measurement is ordered when osteoporosis is suspected.
- 3
Identifying the cause and planning care
The kyphosis is classified as flexible postural, structural such as Scheuermann's disease, fracture-related on a background of osteoporosis, congenital, or following infection or surgery. Each category has a different plan, so a single programme applied to everyone makes no sense however popular it is online.
- 4
Non-surgical care
A physiotherapy programme focused on stretching the front of the chest, strengthening the back extensors and improving trunk stability, along with correcting the seating and working environment, pain relief prescribed by the doctor when needed, bracing in selected growing patients, and osteoporosis treatment with fall-risk reduction in older adults.
- 5
Surgery and follow-up
For severe or progressing kyphosis, or when nerves are compressed, corrective surgery with screws, rods and fusion is discussed, with electrical nerve monitoring during the operation. Graded rehabilitation follows, and imaging is repeated over months to follow fusion and the stability of the correction.
Before the procedure
Bring older lateral X-rays if you have them, because comparing the angle over time can change the decision. Wear clothing that allows the back to be seen from the side. Tell the doctor if you have lost height in recent years, if back pain started suddenly after a fall or after lifting, if you have ever broken a bone after a minor injury, and whether osteoporosis runs in your family. List all your medicines and supplements, especially long-term steroids, thyroid medication and blood thinners. If the patient is an adolescent, describe the stage of growth, sports activity, study hours and the type of chair used. Stop smoking, which harms bone and healing, and follow fasting instructions if surgery has been scheduled.
After the procedure
Stick to the daily exercise programme, because improvement in flexible kyphosis depends on consistency rather than on the intensity of a single session. Set your screen and chair so your gaze is level, and stand up from sitting every half hour. If a brace has been prescribed, wear it for the specified hours and inspect the skin under it daily. If osteoporosis is the underlying cause, continue its treatment and take calcium and vitamin D exactly as your doctor prescribed, and remove fall hazards at home such as loose rugs, poor lighting and a bathroom without grab rails. After surgery, respect the limits on bending, twisting and lifting, walk daily with gradual progression, and care for the wound. **Go to the emergency department immediately for progressive weakness in the legs, numbness between the thighs and around the anus, urinary retention, loss of bladder or bowel control, or a sudden loss of balance and walking ability — these point to pressure on the cauda equina nerves or on the spinal cord and are treated as an emergency.** Contact your doctor quickly for new severe back pain that suggests a fresh fracture, night pain that prevents sleep, fever, unintended weight loss, or any wound problem.
Expected duration
An assessment visit usually takes 20 to 40 minutes, a physiotherapy programme usually runs 8 to 12 weeks, and corrective surgery usually takes 4 to 7 hours.
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