Hunchback is a more familiar term for kyphosis. Wrong posture, osteoporosis, spinal tumours etc. can cause kyphosis.
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Constant pain in the back is a common symptom of kyphosis
What is kyphosis (hunchback)?
Kyphosis is an excessive curvature of the upper back. The spine is normally curved, however, if the curvature is more than 50 degrees it is labelled kyphosis. It is often referred to as hunchback or round back.
The normal human spine…
To understand kyphosis better, it is essential to have a basic knowledge of the human spine.
- At the base of the neck where the spine begins is the cervical spine, this curves inwards.
- The vertebrae forming the spine are called cervical vertebrae.
- The upper back where the spinal vertebrae are connected to the ribs is called thoracic spine, which curves outwards.
- Following that is the lumbar spine, which curves inwards.
- The last stretch of the spine is called sacral spine and it ends in the coccyx or tailbone located at the seat of the buttocks.
The spine has 7 cervical, 12 thoracic and 5 lumbar vertebrae. The 5 sacral vertebrae and the last 3 forming the coccyx or tailbone are fused.
Types of kyphosis:
There are 3 varieties of kyphosis: i) Postural kyphosis, this is the most common type. ii) Scheuermann’s kyphosis iii) Congenital kyphosis.
Causes for kyphosis:
- It is seen mostly during adolescence, except when it is congenital i.e. if noticed in infancy.
- It may occur in old age due to multiple compression fractures of the vertebrae as a result of osteoporosis.
- Other conditions of the spine like degenerative arthritis, spinal tumours or spinal infections for e.g. tuberculosis can lead to kyphosis later on. An inflammatory condition called ankylosing spondylitis is one of the causes.
- Scheuermann’s kyphosis occurs due to a structural deformity in the vertebrae. In this type scoliosis or sideways curvature of the spine may be seen, it is thus called kypho-scoliosis.
- Congenital type occurs prior to birth when the spine is developing in the foetal stage.
- Postural type seen in teenage girls may be due to excessive slouching leading to abnormal positioning of the tissues and bones.
Symptoms of kyphosis:
- The spine may appear normal in mild cases or the back may be hunched.
- There is a constant pain that may not progressively get worse.
- In severe cases, chest pain and/or shortness of breath may occur due to the vertebrae compressing the heart or lungs.
- Tingling, numbness or weakness in the legs should not be overlooked and must be brought to the attention of the family physician.
Complications seen in kyphosis:
Sudden onset of neurological symptoms like tingling, numbness or weakness in the lower limbs indicate compression of the nerves in the vertebral canal and must be evaluated promptly in a hospital.
Similarly, chest pain and shortness of breath require in-depth evaluation.
Diagnosing kyphosis:
X-rays of the spine in the lateral view clinches the diagnosis. A normal X-ray chest should also be taken to assess the heart and lungs.
Routine investigations are conducted if surgery is warranted.
Treatment for kyphosis:
Mild cases or those occurring in advanced old age are not advisable for surgery. They respond well to a combination of physiotherapy, medicines like anti-inflammatory drugs and regular exercises.
Congenital type detected in infancy is ideal for surgery. Braces are inserted so that the vertebrae grow in the proper position.
In cases of severe kyphosis, severe pressure or symptoms in the heart or lungs — surgery is advised in adults. Surgery can be done from the back or front depending on how flexible the spine is.
Drawbacks of surgery are infection and failure of the bones to heal.
Written by Dr Nisreen Nakhoda, General Physician
Photograph via sxc.hu