From the Guidelines
Kyphosis treatment should prioritize non-surgical interventions, with elective spinal osteotomy considered only in highly selected patients with severe kyphosis and significant physical and psychological impairments, as the risks of surgery, including a 4% perioperative mortality and 5% permanent neurologic sequelae, often outweigh the potential benefits 1.
Causes and Symptoms
Kyphosis is characterized by an excessive outward curvature of the spine, leading to a rounded or "hunchback" appearance, most commonly in the thoracic region. The condition can result from various causes, including poor posture, degenerative disc disease, osteoporosis, congenital abnormalities, or Scheuermann's disease. Symptoms may include back pain, fatigue, and difficulty breathing, depending on the severity of the curvature.
Treatment Options
Treatment depends on the cause, severity, and symptoms of kyphosis. For mild postural kyphosis, physical therapy focusing on strengthening back and core muscles, along with posture correction exercises, is typically recommended. Bracing may be necessary for adolescents with Scheuermann's kyphosis when the curve is between 45-75 degrees.
- Non-surgical interventions are preferred due to the high risks associated with surgical procedures, as noted in the 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis 1.
- Elective spinal osteotomy may be considered in patients with severe kyphosis who lack horizontal vision and experience major physical and psychological impairments, but this should be performed at specialized centers by experienced surgeons 1.
Pain Management and Prevention
Pain management can include over-the-counter medications like ibuprofen (400-800mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours). Regular exercise, maintaining good posture, and bone-strengthening activities are important preventive measures, especially for those at risk of osteoporosis.
- It is crucial to weigh the potential benefits of any intervention against the risks, particularly in the context of surgical options, where the evidence suggests significant risks, including perioperative mortality and permanent neurologic sequelae 1.
From the Research
Definition and Treatment of Kyphosis
- Kyphosis is a condition characterized by an excessive outward curve of the spine, leading to a hunched or rounded appearance of the back 2.
- A 6-month randomized controlled trial of spine-strengthening exercise and posture training reduced both radiographic and clinical measures of kyphosis in older adults 2.
Exercise and Physical Therapy for Kyphosis
- Exercise or physical therapy improved kyphosis outcomes, back extensor muscle strength, and endurance in adults with hyperkyphosis 3.
- Meta-analyses showed improvements in health-related quality of life, general pain, and performance on the timed up and go test 3.
Medications for Osteoporosis and Kyphosis
- Bisphosphonates are widely used in the treatment of osteoporosis to reduce fracture risk [(4,5,6)].
- Bisphosphonates reduce the risk of fracture by suppressing bone resorption and increasing bone strength 5.
- There are several important considerations when using bisphosphonates, including appropriate patient selection, pretreatment evaluation, potential adverse effects, patient preferences, and adherence 5.