Kyphosis is a condition in which the thoracic spine is abnormally curved, in the vertical plane, backwards. It is often postural, but may also be due to abnormal vertebral development or shape. The excessive degree of curvature may cause problems in organ-systems such has the heart and lungs.
Most patients have mild kyphosis, which does not require treatment beyond taking over-the-counter pain-relieving medicine for lower back pain, and exercise to strengthen the back muscles. Physical therapy is best combined with core exercises, such as martial arts or Pilates. This also controls and gets rid of back pain if done regularly.
Mild to Moderate Kyphosis
Mild to moderate kyphosis is initially treated with a back brace, until bone growth stops at around 15 years. Surgery is not recommended in most cases due to the risky nature of the procedures. Thus, only severe kyphosis is routinely corrected by surgical techniques, most commonly spinal fusion. This is more so if cardiorespiratory problems arise due to kyphosis. Furthermore, a very prominent curvature, which causes severe intractable pain or compromises spinal integrity, is also an indication for surgical intervention.
In the case of postural kyphosis, correction of posture, along with the avoidance of activities like carrying heavy loads on the back, usually leads to a good outcome.
Scheuermann’s kyphosis (i.e. developmental kyphosis) can be treated depending on the person’s age, gender, magnitude of the curve and its rigidity. This curve usually increases during the growth spurt and may thereafter become static. If the curve is severe, surgery is advised, but the prognosis for normal spinal function is extremely good, because the condition does not progress afterwards.
With congenital kyphosis, surgical correction is often advised. Surgery is usually followed up by back bracing for several months to allow the spine to heal properly without undergoing strain. However, this does not restrict normal physical activity after about a month or two. Athletics should be resumed only after full and normal spinal function is recovered, which is within a year post-operatively.
Skilled surgery and careful follow-up produce a normal spinal outcome in the vast majority of cases.
Complications of Surgery
Spinal fusion is rarely required, but may entail complications, such as:
- Post-operative infection
- Hemorrhage around the surgical site
- Nerve damage with loss of visceral function, such as bowel and bladder continence
Prognosis without Treatment
Untreated severe or progressive kyphosis is also associated with limiting complications, which can significantly reduce the quality of life. These include severe and chronic back pain, back deformity, poor respiratory capacity and neurological symptoms and signs, such as limb paralysis or weakness.