Kyphosis

What is kyphosis?

A healthy spine already has a gentle forward curve in the upper back. Kyphosis is when that curve becomes more pronounced than usual, rounding the upper back forward - what many people call a hunchback or roundback. When the rounding is marked, it is sometimes described as hyperkyphosis.

There are several forms. Postural kyphosis is a flexible rounding linked to posture and muscle weakness, most often in younger people, and it can usually be improved actively. Scheuermann’s kyphosis develops during the teenage years when the vertebrae grow into a wedge shape, creating a stiffer, more fixed curve. Age-related (degenerative) kyphosis becomes more common in later life as discs flatten, supporting muscles weaken, and small compression fractures let the spine tip forward.

The reassuring part: many people with kyphosis have little or no pain, and where treatment is needed, most are managed without surgery. Our role is to work out which type of kyphosis you have and guide you to the least invasive option that helps.

Symptoms to look for

Kyphosis often develops slowly, and the effects range from purely cosmetic to genuinely uncomfortable:

• A rounded upper back or visible hump - the most recognizable sign, sometimes more obvious when bending forward.
• Back pain and stiffness - typically across the upper or mid back, and sometimes fatigue from the muscles working to hold you upright.
• Tight hamstrings - a common finding, particularly in Scheuermann’s kyphosis.
• Rounding that worsens through the day or a feeling of being pulled forward as tiredness sets in.
• Nerve or breathing symptoms (in severe cases only) - a very pronounced curve can occasionally affect the nerves or reduce the room the lungs have to expand.

What causes kyphosis?

The cause depends on the type. Postural kyphosis stems from habitual slouching and weak supporting muscles, with no change in the bones themselves. Scheuermann’s kyphosis arises when several vertebrae develop into a wedge shape during adolescent growth, for reasons that are not fully understood but can run in families. Age-related kyphosis reflects years of wear - flattening discs, weakening muscles, and osteoporosis, which can lead to the compression fractures that tip the spine forward.

Less commonly, kyphosis follows a spinal injury, is present from birth (congenital), or develops after certain spinal conditions or surgery. Reduced bone density is an important risk factor, because it makes the small fractures that drive age-related kyphosis more likely.

How we diagnose it

Diagnosis begins with your history and a physical examination, including a forward-bend test to see how the curve behaves and whether it is flexible or fixed, along with a neurological check if you have any leg symptoms. Standing X-rays confirm the size and shape of the curve and help identify the type. An MRI may be added when nerve symptoms are present, and bone-density testing is arranged where osteoporosis or a compression fracture may be involved.

We also match the imaging to how you actually feel, because a curve on a scan does not always explain a person’s symptoms - we treat the person, not the picture. Your assessment is led by a US board-certified neurosurgeon.

Treatment - least invasive first

We follow a measured, surgery-last approach. The right path depends on the type of kyphosis, your age, whether the curve is progressing, and how much it affects you.

• Conservative care (first line for most). Simple pain relief, staying active, and attention to posture help many people, particularly with flexible, posture-related rounding.
• Physiotherapy and exercise. A structured physiotherapy program to strengthen the back and core, stretch tight muscles, and improve posture can ease pain and, in flexible curves, improve the rounding.
• Bracing (for some growing children and teenagers). In a young person still growing, a brace may be used for Scheuermann’s kyphosis to help manage the curve before growth is complete.
• Treating an underlying fracture. When kyphosis is driven by a painful osteoporotic compression fracture, a minimally invasive procedure such as kyphoplasty or vertebroplasty may stabilize the bone and relieve pain.
• Deformity correction (reserved for severe or progressing curves). When a curve is severe, clearly progressing, or causing disabling pain or nerve compression, scoliosis and deformity correction surgery can realign and stabilize the spine. This is a major procedure, considered only when the benefits clearly outweigh the alternatives.

If you have already been told you need surgery, we are glad to give an honest second opinion on whether a less invasive path could work for you.

What to expect

For most people, kyphosis is managed rather than cured, with the aim of easing pain, protecting movement, and preventing further progression. Improvement with conservative care and physiotherapy is usually gradual, over weeks to months, and flexible curves tend to respond better than fixed ones. If a procedure is needed for an underlying fracture, pain relief can come more quickly. Corrective surgery is a bigger undertaking, with recovery over several months and a guided return to activity. Your surgeon will explain the likely timeline for your specific case, and the plan is built around you with clear explanations at every step.