Kyphosis
Excessive forward curvature of the thoracic (upper) spine
Kyphosis refers to an exaggerated forward rounding of the spine, most commonly in the thoracic (mid-back) region. While the thoracic spine naturally curves 20–45 degrees, kyphosis is diagnosed when the curve exceeds 50 degrees. It ranges from postural kyphosis — a flexible, habit-related rounding — to structural forms including Scheuermann's kyphosis (a developmental condition in adolescents) and kyphosis caused by osteoporotic vertebral compression fractures in older adults. Severe kyphosis can compress the lungs, cause chronic pain, and significantly affect quality of life.
Symptoms
- Visible rounding or "hunchback" appearance of the upper back
- Mild to moderate upper and mid-back pain or fatigue
- Stiffness in the thoracic spine
- In severe or Scheuermann's kyphosis: rigid, fixed curve that does not correct with posture changes
- Height loss over time as vertebrae collapse (osteoporotic kyphosis)
- Breathing difficulties or reduced lung capacity in severe cases
- Neurological symptoms (rare): weakness or numbness if the cord is compressed
Causes & Risk Factors
- Poor posture (postural kyphosis) — the most common and correctable form
- Scheuermann's kyphosis — a developmental condition where the front of vertebrae grow less than the back during adolescence
- Osteoporosis — vertebral compression fractures cause vertebrae to collapse anteriorly, producing a wedge shape
- Congenital kyphosis — vertebrae form abnormally during fetal development
- Degenerative disc disease — disc height loss causes forward collapse of the upper spine
- Inflammatory conditions such as ankylosing spondylitis
- Neuromuscular conditions (cerebral palsy, muscular dystrophy)
Treatment Options
Conservative (Non-Surgical)
- Postural training and physical therapy — the mainstay for postural kyphosis
- Core strengthening and back extension exercises
- Spinal bracing — Milwaukee brace or thoracolumbosacral orthosis (TLSO) for Scheuermann's kyphosis in growing adolescents
- Osteoporosis treatment to prevent further vertebral collapse in elderly patients
- Pain management with NSAIDs or physical modalities
- Breathing exercises to maintain lung function in moderate-to-severe curves
Surgical Options
- Posterior spinal fusion with instrumentation — corrects the curve by fusing vertebrae into a more upright alignment; the most common procedure for structural kyphosis exceeding 70–75 degrees
- Osteotomy — vertebral bone cuts performed to achieve greater correction in rigid or severe deformities
- Kyphoplasty or vertebroplasty for fracture-related kyphosis (stabilizes the fractures)
When to see a spine specialist
See a spine specialist if your upper back curve is worsening, causing pain that limits daily activities, or if breathing is affected. Adolescents with a rigid curve that does not straighten when lying down should be evaluated for Scheuermann's kyphosis. Adults over 60 with new kyphosis should be screened for osteoporosis and vertebral fractures.
Frequently Asked Questions
What is the difference between postural kyphosis and Scheuermann's kyphosis?
Postural kyphosis is a flexible rounding — when you lie on your back or consciously straighten up, the curve corrects itself. It is caused by habit and muscle weakness, not structural bone changes. Scheuermann's kyphosis is a rigid, structural deformity — the vertebrae are actually wedge-shaped due to abnormal growth, and the curve does not correct with position changes. X-rays typically show three or more consecutive vertebrae wedged 5 degrees or more in Scheuermann's.
Can kyphosis be corrected with exercise?
Postural kyphosis can be significantly improved with consistent back extension exercises, core strengthening, and postural correction habits. Structural kyphosis — whether from Scheuermann's disease or osteoporotic fractures — cannot be fully corrected with exercise alone. However, physical therapy can reduce pain, prevent worsening, and improve functional capacity even in structural cases. Bracing is most effective when started during the adolescent growth spurt for Scheuermann's kyphosis.
When is surgery recommended for kyphosis?
Surgery is generally recommended when: the curve exceeds 70–75 degrees and is progressing; neurological symptoms develop; the deformity causes intractable pain unresponsive to conservative care; or breathing capacity is significantly reduced. Surgery carries meaningful risks in a complex area of the spine and requires a highly experienced spinal deformity surgeon. A thorough evaluation including CT, MRI, and pulmonary function tests is completed before planning.
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Medical disclaimer: This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment decisions. Last reviewed March 2026. ICD-10: M40.04.