Alternate Names: Scheuermann disease; Roundback

Causes and Risks:

Kyphosis is a spinal deformity that can result from trauma, developmental problems or degenerative disease. Kyphosis can occur at any age although it is rare at birth.

Adolescent kyphosis, also known as Scheuermann’s disease, results from wedging of several consecutive vertebrae. The cause of Scheuermann’s disease is unknown.

In adults kyphosis can be seen as a result of osteoportic compression fractures, degenerative disease (like arthritis), or spondylolisthese (slipping of one vertebra forward on another).

Other causes of kyphosis include infection (such as tuberculosis), spina bifida (congenital deformity with incomplete formation of part of the spine), disk degeneration, endocrine diseases, Paget’s disease, polio, and tumors.

Kyphosis can also be seen in association with scoliosis (an abnormal sideways curvature of the spine seen in children and adolescents). Risk factors are related to the causes.

Prevention:

Treating and preventing osteoporosis can prevent many cases of kyphosis in the elderly. Early diagnosis and bracing of Scheuermann’s disease can reduce the need for surgery, but there is no way to prevent the disease.

Symptoms:

• mild back pain
• fatigue
• tenderness and stiffness in the spine
• round back appearance

Signs and Tests:

Physical examination confirms the abnormal curvature of the spine. The exam should also look for any neurologic changes (weakness or changes in sensation) below the level of the curve.

A spine X-ray will be done to document the severity of the curve and allow serial measurements to be performed.

If there is any question of a tumor, infection or neurologic symptoms then an MRI may be ordered.

Treatment:

Treatment depends on the cause of the disorder:

Congenital kyphosis requires corrective surgery at an early age.

Sheuermann’s disease is initially treated with a brace and physical therapy. Occasionally surgery is needed for large (greater than 60 degrees), painful curves.

Multiple compression fractures from osteoporosis can be left alone if there is no neurologic deficit or pain, but the osteoporosis needs to be treated to help prevent future fractures. For debilitating deformity or pain surgery is an option.

Kyphosis secondary to infection or tumor needs to be treated more aggressively, often with surgery and medications.

Treatment for other types of kyphosis includes identifying the cause of the kyphosis. Surgery may be indicated if neurological symptoms occur.

Prognosis:

Adolescents with Scheuermann’s disease tend do well even if they need surgery, and the disease stops once they stop growing. If the kyphosis is due to degenerative joint disease or multiple compression fractures, correction of the defect is not possible without surgery and improvement of pain is less reliable.

Complications:

• disabling back pain
• neurological symptoms including leg weakness or paralysis
• decreased lung capacity

Call your health care provider if you have symptoms of kyphosis.