Adult Kyphosis

Written by Michael S. Chang, MD

Kyphosis refers to any abnormal amount of forward curvature in the spine. Although it can occur at any location in the spine, it is most commonly observed in the thoracic region, where it is often referred to as a "hunchback" deformity. There are many potential causes of kyphosis in adults, but the most common two are a result of 1) osteoporosis and 2) previous spinal surgery.

Osteoporosis refers to the condition in which a person's bone becomes weaker and more porous with age. Although it can affect males, it most commonly affects women who are post-menopause. Eventually, the bone weakens to the point where the spine cannot support the weight of the body and it buckles, resulting in what is called an osteoporotic compression fracture. Although these types of fractures are not dangerous, they do alter the shape of the spine, causing people to gradually bend forward as if they were hunched over.

A similar process can occur after spinal fusion surgery. Because the fused portion of the spine no longer moves, the remaining spine above the surgery site has to make up for the loss of motion. This results in greater wear and tear of the portion of the spine above the fusion. With time, a person may notice that he or she is gradually leaning forward.

Regardless of cause, the most common complaint other than cosmetic deformity that accompanies kyphosis is pain. The pain is generally localized in the area of the deformity and may be quite severe in intensity. It is also often related to physical exertion, but may be present even at rest. In severe cases, an individual may lose the ability to stand up straight.

Despite the often severe level of pain and discomfort it causes, kyphosis is generally not dangerous. For most patients, a combination of physical exercises to strengthen postural muscles along with non-steroidal anti-inflammatories is sufficient. For people who fail to improve with these methods, who have a progressively worsening deformity, or who have an inability to functionally stand, referral to a spine surgeon who is fellowship trained in spinal deformity, specializes in adult deformity and a member of the Scoliosis Research Society is a good next step. Surgical treatment for this condition can be technically demanding so it is appropriate to discuss all treatment options.