Hyperkyphosis

By John J. Vaughan, M.D.

The term kyphosis is used to describe the normal curve of the thoracic spine. Sometimes, adolescents may develop an excessive degree of kyphosis, called hyperkyphosis.

Kyphosis is measured on a lateral radiograph of the thoracic spine, taken with the patient standing. In normal adolescents, the kyphosis measures on average twenty to forty degrees. Measurements greater than this are considered hyperkyphotic.

Several conditions may lead to hyperkyphosis,but two of the most common are Scheuermann's kyphosis and postural roundback. It is necessary to distinguish between these two conditions if proper treatment is to be provided.

Scheuermann's kyphosis typically presents when patients are in the early teenage years. Medical treatment is most commonly sought because of the physical appearance of the deformity. The deformity may sometimes be painful.

Physical examination of patients with Scheuermann's kyphosis shows a hyperkyphosis in the thoracic region. This deformity is apparent when patients are viewed from the side. The kyphosis tends to be inflexible upon forward bending or extension. The kyphosis seen in this condition has been likened to an "A-frame" deformity. In contrast, postural roundback is a nonstructural deformity that tends to be flexible upon bending.

Neurologic deficits are uncommon with Scheuermann's kyphosis. Not infrequently, though, hamstring tightness is seen.

Radiographs of the spine can confirm the presence of Scheuermann's kyphosis. The radiographic diagnostic criteria for this condition are hyperkyphosis with wedging of five degrees or more of three central adjacent vertebrae. These radiographic findings are not seen with postural roundback.

In most cases, Scheuermann's kyphosis can be successfully treated without surgical intervention. If the patient is skeletally immature, a brace is usually effective. The type of brace commonly used is a CTLSO (cervical thoracic lumbar sacral orthosis) or Milwaukee brace. This type of brace provides the necessary three-point bending corrective forces to the spine.

When brace treatment is unsuccessful, it is sometimes necessary to proceed with surgical intervention. A typical operative correction of Scheuermann's kyphosis involves an anterior release of the spine followed by a posterior spinal fusion with instrumentation. Figures 1 and 2 show a patient with Scheuermann's kyphosis treated surgically at the Kentucky Spine Institute.

In Kentucky, school children in the sixth and eighth grades are screened for spinal deformities including scoliosis and hyperkyphosis. School nurses, physicians, and other health care professionals provide this service.

If a deformity is suspected, the child's parents or guardians are notified and evaluation by a specialist is recommended.


Figure 1: A 16-year-old boy with an 84º Scheuermann's kyphosis that did not respond to bracing.

    Figure 2: The patient underwent an anterior release followed by a posterior spinal fusion. The postoperative kyphosis measured 42º.

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Last Updated: 10/4/03