Kyphosis

In this condition, the upper spine curves forward more than usual, giving children a rounded or "hunchback" appearance. Kyphosis can affect up to 10% of school-aged children.

About kyphosis

The spine is made up of small, stacked bones called vertebrae separated by soft, shock-absorbing spinal discs. Everyone's spine curves a little, but a child with kyphosis will have a curve that's 50 degrees or more. This condition typically occurs in the upper back (known as the thoracic spine), though it can also develop in the neck and low back (also known as the cervical and lumbar spine).

There are different types of kyphosis that can range in severity:

• Congenital kyphosis is when a child is born with incomplete or fused vertebrae that affect the spine's forward curvature.
• Scheuermann's disease is a congenital condition where vertebrae are more triangular instead of the usual rectangle shape, causing a forward bend in the spine.
• Postural kyphosis is a mild form of this condition that can develop in adolescence when a child frequently slouches, which can hinder the proper development of the spine and surrounding muscles.
• Compression fractures may be at risk for developing kyphosis. Compression fractures can occur from injury/trauma or preexisting genetic or medication-related conditions. The location and severity of the fracture will determine your child's need for ongoing monitoring.

Kyphosis can also develop during adolescence as a result of other conditions.

Experts in kyphosis

At the AIM Spine Center at Children's Wisconsin, our pediatric spine experts work together to provide outstanding and compassionate care for even the most complex spinal disorders and spine trauma in infants, children and teens. If your child has already been diagnosed at another center, we invite you to get a second opinion for kyphosis at the AIM Spine Center.

What causes kyphosis?

Some children are born with kyphosis because of a spinal abnormality that forms when they're still in the womb. This abnormality can develop spontaneously or run in families. Other times kyphosis develops later in life. Scheuermann's disease usually isn't detected until around puberty, when a child's growth spurt makes the curve more obvious. Other neuromuscular conditions (including spina bifida, cerebral palsy, osteogenesis imperfecta and muscular dystrophy); spinal trauma, infections or tumors; and even poor posture can also cause a child to develop kyphosis.

Why is kyphosis a concern?

When a child has a spinal abnormality such as Scheuermann's disease, it can prevent the vertebrae from moving and functioning normally, putting extra stress on a disc that causes it to deform. This can compress the spinal cord and lead to the development of Schmorl's nodes, which is when a spinal disc's cartilage pushes into the vertebra above or below it. When kyphosis causes pain, it can affect a child's quality of life, disrupting sleep, school, sports and other activities. If the curve is severe, it can squeeze the lungs and affect breathing.

What are the symptoms of kyphosis?

This condition often causes no problems, but signs and symptoms could include:

• Hump in the upper back
• Rounded shoulders
• Difference in height or position of shoulders or shoulder blades
• Head bends forward
• Back/neck pain
• Stiffness
• Reduced range of motion
• Tight hamstring muscles
• Fatigue
• Difficulty breathing (in severe cases)

Always consult your child's doctor if you have concerns or notice anything new.

How is kyphosis diagnosed?

Some signs of kyphosis will be detectible during a physical examination. The doctor might use the following imaging tools to assess your child's spine:

• EOS scanner - Children's was one of the first pediatric hospitals in the nation to have this scanner, which provides detailed, 3D images and limits radiation exposure.
• CT scan - More detailed than an X-ray, a CT scan uses a combination of X-rays and computer technology to produce cross-sectional, detailed images of parts of the body, including the bones, muscles, fat and organs.
• MRI - Uses a magnet, radio waves and a computer to create very detailed, 3D still and moving images.

Treatment for kyphosis

The severity of this condition varies, and more mild cases might not require treatment at all. Children's spinal specialists will recommend the best treatment for your child based on:

• Your child's age, overall health and medical history
• Extent of the disease
• Your child's tolerance for specific medications, procedures or therapies
• Expectations for the course of the disease
• Your opinion or preference

Treatment could include:

Medical management - Anti-inflammatory medications can relieve children's pain.

Bracing - If your child's spine is still growing, your child's doctor might recommend a back brace to keep the curve from getting worse.

Physical therapy - Physical therapy can ease pain and increase range of motion. Our physical therapy program offers experts trained the Schroth method for treating spinal curvature and a rehabilitation space designed for spinal conditions.

Surgical repair - Surgery isn't always required to treat kyphosis. But if your child's spinal curve is large or is causing frequent pain, your child's doctor might recommend surgery. Spinal fusion surgery involves fusing segments of the spine together with metal rods and screws to correct the rounding and prevent the curve from getting worse. Your child's spinal care team will advise you on the best options for your child.

Postoperative care for your child

During the first several hours after the procedure, your child will likely be drowsy from the anesthesia and medications given to ease anxiety and pain. Over time, your child will become more alert. Some children might require recovery time in the pediatric intensive care unit (PICU).

Your child might need other supportive equipment while in the hospital. They will be kept as comfortable as possible with medications that relieve pain and anxiety, and the staff might also ask for your input on how best to soothe and comfort your child. You will learn how to care for your child at home and will receive instructions on medications, activity limitations and follow-up appointments before your child is sent home.

Care for your child at home following kyphosis surgical repair

Most patients are able to leave the hospital after a few days. Your physician might recommend pain medications, such as acetaminophen or ibuprofen, to keep your child comfortable. Your child could become tired more quickly than before surgery, and bending motions can cause some pain initially. Most children return to school 1-6 weeks after surgery, and it might be 3-6 months or longer before your child can return to gym class or sports. Your child might need physical therapy as part of the recovery process. Learn more about what to expect after spinal surgery.

Long-term outlook after kyphosis

The prognosis for kyphosis is generally very good, especially with early intervention while a child is still growing. The spine curvature usually stops progressing after a child finishes growing. Kyphosis can return, and your child will need to be monitored by an orthopedic specialist long-term in case new problems develop.