Medicines for Kyphosis

What it is

Kyphosis is an excessive outward (forward) curve of the upper part of the spine, causing the upper back to appear rounded or hunched. The spine normally has a gentle natural curve in the upper back, but in kyphosis this curve is exaggerated. Kyphosis varies greatly in cause and severity. There are several types and causes: postural kyphosis, which is common (particularly in teenagers and young people) and is related to posture — the curve is flexible and can be corrected by standing up straight, and it is usually mild and not associated with structural changes in the spine; Scheuermann’s kyphosis, which develops during growth (in adolescence) due to the vertebrae (spine bones) developing into a wedge shape, causing a more fixed curve; congenital kyphosis, present from birth due to the spine not forming properly; and kyphosis in older adults, which can develop due to age-related changes, weakening of the bones (osteoporosis, which can cause the vertebrae to compress or fracture and lead to a curved posture), or other conditions. The features of kyphosis can include a visibly rounded or hunched upper back; in mild or postural cases, it often causes no symptoms other than the appearance, while more significant kyphosis can cause back pain, stiffness, tiredness of the back muscles, and, in severe cases, other effects. The severity and impact depend greatly on the type, the degree of the curve, and the cause. Kyphosis is assessed to determine the type, cause, and severity, and management depends on these: mild postural kyphosis is often managed with posture awareness and exercises, and needs no other treatment; Scheuermann’s and other structural kyphosis are managed according to the severity, sometimes with exercises and monitoring, and, for more significant curves (particularly in growing children), a brace or, occasionally, surgery; and kyphosis related to osteoporosis is managed by treating the osteoporosis and managing the symptoms. The key messages are that kyphosis is an excessive forward curve of the upper spine causing a rounded upper back, that it ranges from mild and painless (often postural) to more significant, and that it is managed according to the cause and severity.

How it is treated

Kyphosis is managed according to its type, cause, and severity — ranging from posture awareness and exercises for mild postural kyphosis, to bracing or surgery for more significant structural curves, and treating the underlying cause (such as osteoporosis) where relevant. Assessment is important to determine the type and cause of the kyphosis (such as postural, Scheuermann’s, congenital, or age/osteoporosis-related) and its severity — this involves examination (including whether the curve is flexible or fixed), and, where relevant, X-rays (to measure the curve and assess the spine) and other tests; this guides management. For mild postural kyphosis (common in young people, where the curve is flexible), management is usually simple: posture awareness and exercises to strengthen the back and improve posture, which often improve the appearance, along with reassurance, as it is usually not associated with structural spine problems and does not usually progress or cause significant problems. For Scheuermann’s kyphosis and other structural kyphosis, management depends on the severity and, in growing children, the risk of progression: milder cases may be managed with exercises, physiotherapy, monitoring, and pain relief for any discomfort; for more significant curves in growing children (where the curve is at risk of worsening), a back brace may be used to help prevent progression while the child is still growing; and for severe curves, curves that are progressing significantly, or those causing significant problems or pain, surgery to correct and stabilise the spine may be considered. Congenital kyphosis is managed by specialists, often with surgery where needed. For kyphosis in older adults related to osteoporosis (where weakened or fractured vertebrae cause the curve), an important part of management is treating the osteoporosis (to strengthen the bones and prevent further fractures) and managing any pain and the effects, along with physiotherapy and support; managing the underlying condition is key. Across the types, physiotherapy, exercises, staying active, pain relief for any discomfort, and support help manage symptoms and maintain function and posture. Management is tailored to the individual, and specialist (orthopaedic or spinal) input is used for more significant or structural kyphosis. The reassuring messages are that kyphosis ranges from mild and painless (often postural, and helped by posture and exercises) to more significant (managed with physiotherapy, bracing for growing children with significant curves, or surgery for severe cases), and that treating any underlying cause (such as osteoporosis) is important; so assessment of the type and severity, and management tailored to these, are the keys to managing kyphosis.