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Kyphosis in Children

What is kyphosis?

A normal spine, when viewed from behind appears straight. However, a spine affected by kyphosis shows evidence of a forward curvature of the back bones (vertebrae) in the upper back area. This gives the child an abnormally rounded or "humpback" appearance.

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Kyphosis is defined as a curvature of the spine measuring 50° or greater on an X-ray (a test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film). The normal spine can bend from 20° to 45° of curvature in the upper back area.

Kyphosis is a type of spinal deformity.

What causes kyphosis?

Kyphosis can be congenital (present at birth), or due to conditions that may include the following:

  • Metabolic problems

  • Neuromuscular conditions

  • Osteogenesis imperfecta (also called "brittle bone disease"). A condition that causes bones to fracture with minimal force.

  • Spina bifida

  • Scheuermann's disease. A condition that causes the vertebrae to curve forward in the upper back area. The cause of Scheuermann's disease is unknown and is commonly seen in males.

  • Postural kyphosis. The most common type of kyphosis. It generally becomes noticeable in adolescence and can be associated with slouching versus a spinal abnormality. Exercise is used to help correct posture.

Kyphosis is more common in females than males.

What are the symptoms of kyphosis?

The following are the most common symptoms of kyphosis. However, each child may experience symptoms differently. Symptoms may include:

  • Difference in shoulder height

  • The head bends forward compared to the rest of the body

  • Difference in shoulder blade height or position

  • When bending forward, the height of the upper back appears higher than normal

  • Tight hamstrings (back thigh) muscles

Back pain, pain down the legs, and changes in bowel and bladder habits are not commonly associated with kyphosis. A child experiencing these types of symptoms needs immediate medical evaluation by a healthcare provider.

The symptoms of kyphosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always talk with your child's healthcare provider for a diagnosis.

How is kyphosis diagnosed?

The healthcare provider makes the diagnosis of kyphosis with a complete medical history of the child, physical exam, and diagnostic tests. The healthcare provider obtains a complete prenatal and birth history of the child and asks if other family members are known to have kyphosis. The healthcare provider also will ask about developmental milestones since some types of kyphosis can be associated with other neuromuscular disorders.  Developmental delays may need further medical evaluation.

Diagnostic procedures may include the following:

  • X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. This test is used to measure and evaluate the curve. With the use of a full-spine X-ray, the healthcare provider measures the angle of the spinal curve. A determination for treatment can often be made based on this measurement.

  • Bone scans. A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation. This test is to rule out any infection or fractures.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.

  • Computed tomography scan (also called a CT or CAT scan). This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. 

  • Blood tests

Early detection of kyphosis is important for successful treatment. Pediatricians or family healthcare providers, and even some school programs, routinely look for signs that kyphosis may be present.

Treatment of kyphosis

Specific treatment for kyphosis will be determined by your child's healthcare provider based on:

  • Your child's age, overall health, and medical history

  • The extent of the condition

  • Your child's tolerance for specific medicines, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:

  • Observation and repeated exams. The child will need observation and repeated exams. Progression of the curve depends on the amount of skeletal growth, or how skeletally mature, the child is. Curve progression usually slows down or stops after the child reaches puberty.

  • Bracing. If the child is still growing, the healthcare provider may prescribe a brace. The type of brace and the amount of time spent in the brace will be determined by your child's healthcare provider.

  • Surgery. In rare instances, surgery is recommended when the curve measures 75° or more on X-ray and bracing is not successful in slowing down the progression of the curve.

Long-term outlook for a child with kyphosis

The treatment of kyphosis is individualized for each child. It depends on the diagnosis, his or her age, amount of curvature, and amount of time remaining for skeletal growth. Kyphosis will require frequent exams by your child's healthcare provider to monitor the curve as your child grows and develops. Early detection is important. If left untreated, kyphosis can lead to problems with lung function.

Medical Reviewers:

  • Joseph, Thomas N., MD
  • Moloney Johns, Amanda, PA-C, MPAS, BBA