Kyphosis is a forward curve of your upper back. It can cause your neck to jut forward and give you a rounded back appearance. There are two different kinds of kyphosis, and they can both affect babies, children, teenagers, and adults. The first type, postural kyphosis, is caused by bad posture and can be corrected by the patient. The second type is caused by a structural disorder and cannot be fixed without medical treatment. All spines should have a natural rounding in the upper back, and that's called kyphosis. How is that natural rounding different from kyphosis that causes pain and other symptoms? That's right: when viewed from the side, the spine has both inward and outward curves. These curves help our back carry our weight and are also important for flexibility. Kyphosis means the spine curves inward; lordosis means the spine curves outward. There are two kyphotic and two lordotic spinal curves in a normal spine. Your neck (cervical spine) and low back (lumbar spine) have a lordotic curve.
Your mid back (thoracic spine) and pelvis (sacrum) have a kyphotic curve. So your thoracic spine should have a kyphotic curve, or a natural rounding. However, if your spine curves too much, that extreme kyphosis curve can cause pain and other symptoms. Remember, kyphosis isn't a disorder. Instead, it's a description of a curve. Postural kyphosis comes from bad posture (no surprise there). However, with the second type of kyphosis, structural kyphosis, the causes are more complex. Disease or fractures can damage your vertebrae, causing them to collapse on one another and creating a curve in your spine. Some diseases or disorders associated with kyphosis are: Although it's very rare, some people are born with kyphosis; that's called congenital kyphosis, and it's caused by missing or incompletely form parts of the spine. Finally, some adolescents develop Scheuermann's disease, which is considered a structural kyphosis. It occurs when the front of the spine doesn't grow as fast as the back of the spine.
Doctors have found that some children begin to develop this type of kyphosis between the ages of 12 and 15—generally a period of bone growth. However, doctors don't know why some children develop this disease. What are some non-surgical ways to deal with kyphosis? The type of treatment you receive will depend upon the cause of your kyphosis. If your kyphosis is caused by a spine fracture, you can try: If your kyphosis is caused by poor posture, you can try: If your kyphosis is caused by a structural problem, you can try: Will I need surgery? If your kyphosis is severe—a curve greater than 70°—your doctor may recommend surgery. He or she may also recommend surgery if your curve is progressing rapidly, your balance is affected, your nervous system is affected, or you have persistent pain. To correct the abnormal curve, surgeons try to fuse the spine into a more normal curve. Spinal fusion involves placing small pieces of bone between the vertebrae.
Over time these pieces of bone will grow and join or "fuse" to the vertebrae on either side together. However, such fusion takes time to occur. To hold the spine in the correct position during the months that fusion takes to occur, the surgeon will use special spinal instruments. These instruments include small steel or titanium rods, bars, wire, plates, and screws. The instruments are attached to the spine and help hold the spine in a more normal curve. After surgery, the instruments cannot be seen as they are small and are inside your body. Another surgical option is kyphoplasty. It's a minimally invasive technique that can help restore the height of a vertebra that has been fractured, and thus help to reduce your kyphosis.I wore a hard plastic brace around my torso from ages 8 to 16 to treat scoliosis, or spinal curvature. Bracing has been standard treatment in children for the past five decades, and I wore my brace diligently, if awkwardly, in the hope that it would contain my S-shaped curvature and stave off the need for spinal fusion surgery.
By the time I was 16 and full-grown — and no longer considered at high risk for curve progression — my most prominent spinal curve had stabilized at 45 degrees. I’d narrowly escaped surgery and the complications that can accompany it. My orthopedist told me my treatment was done. I’ve discovered in the years since that scoliosis is not something you endure and outgrow, like pimples and puberty. Significant curves often grow throughout adulthood, and can cause deformity, arthritis, pinched nerves, herniated discs, muscle spasms and reduced mobility and lung capacity. Now, at the ripe age of 38, I find myself with a 55-degree upper curve, a 33-degree lower curve, consistent pain — and no standard treatment to follow. Some orthopedists have recommended surgery; others have suggested conventional physical therapy. None can say whether either protocol will eliminate pain, and until recently these were my only options. Now there may be another: an exercise regimen called the Schroth method.
Developed in the 1920s in Germany by Katharina Schroth, the technique is a standard treatment for scoliosis in children and adults in several European countries. The therapy, tailored to each patient’s curves, focuses on halting curve progression, reducing pain, and improving posture, strength and lung function. The exercises include stretching, strengthening and breathing techniques that counteract the rotation of spinal curvatures. Patients are supposed to do them at home and incorporate postural corrections into their daily lives. Dozens of studies from abroad have found that the Schroth method and variations of it improved patient outcomes and reduced the need for surgery in people of all ages. In one study, patients who didn’t do Schroth exercises saw their spinal curves progress up to nearly three times more than those of patients who did practice the exercises. In another study, 813 Schroth patients increased their ability to expand their chests to breathe by an average of 20 percent.
None of these studies were large, randomized controlled trials, and the Scoliosis Research Society, which influences guidelines for care in the United States, does not officially recognize physical therapy as a treatment option. “But the mind-set of the American scoliosis practitioner is shifting,” said Dr. Michael Mendelow, an orthopedic spinal surgeon at Shriners Hospitals for Children in Greenville, S.C. Boston Children’s Hospital and Hospital for Special Surgery in Manhattan are among the health-care institutions that now have Schroth therapists. Insurers are starting to cover the treatment and the braces favored by Schroth experts, and certified practices have popped up across the country. Teaching centers such as Columbia University and Morgan Stanley Children’s Hospital of NewYork-Presbyterian are sponsoring Schroth-related conferences. “If you look critically at the body of literature, there is evidence that, when properly done in the right situation, with the right therapist and the right patient, Schroth can change the chance of curve progression,” said Dr. Michael Vitale, chief of pediatric orthopedics at Morgan Stanley Children’s Hospital.
Even the Scoliosis Research Society is taking a second look. “We’re primarily using Schroth on people who are being braced — I think it will make bracing more successful,” said Dr. M. Timothy Hresko, chairman of the research society’s nonoperative committee and associate professor of orthopedic surgery at Harvard. At the University of Alberta in Canada, researchers recently completed a randomized pilot study of Schroth, financed in part by the research society. The six-month study showed that adolescents with scoliosis who did these exercises fared better than teenagers who didn’t with regard to curve progression, pain and self-image. A larger multicenter randomized trial, funded by the SickKids Foundation and the Canadian Institutes of Health Research, is now enrolling adolescents. Many scoliosis patients, in increasing discomfort, aren’t waiting for new study results. At age 15, Rachel Mulvaney of Mount Sinai, N.Y., went to a clinic run by Beth Janssen, a Schroth therapist, in Stevens Point, Wis.