Kyphosis & Hyperkyphosis

Kyphosis is a forward curve of the upper back. A small kyphotic curve is normal, but when it becomes too pronounced it can cause pain, a hunched appearance, and in severe cases breathing or balance problems. Treatment depends on the cause, the patient's age, and the size of the curve.

What's happening in your spine

The thoracic spine (upper back) is shaped like a gentle outward arch. When that arch is exaggerated, the head and shoulders shift forward and the muscles of the upper back have to work harder to hold you up. Causes range from poor posture in adolescence to vertebral compression fractures in older adults to growth-plate problems like Scheuermann's disease.

Common symptoms

• Visible rounding of the upper back
• Back pain and muscle fatigue, especially with prolonged sitting or standing
• Stiffness, particularly in the morning
• Loss of height over time
• In severe cases: shortness of breath, balance problems, or difficulty looking straight ahead

Causes & risk factors

Common causes include postural kyphosis (often in adolescents and young adults), Scheuermann's kyphosis (a developmental problem of the vertebrae during growth), osteoporosis-related vertebral compression fractures in older adults, ankylosing spondylitis, congenital vertebral abnormalities, and prior spine surgery or radiation.

How it's diagnosed

Evaluation includes a posture exam, an Adam's forward bend test, and measurement of curve size on X-ray (Cobb angle). MRI or CT may be added if there is concern about a fracture, the spinal cord, or the underlying bone.

Treatment options

Many cases are managed without surgery, especially in younger patients with flexible curves.

• Physical therapy focused on extension, core strength, and postural retraining
• Bracing for adolescents with progressive Scheuermann's kyphosis
• Treatment of underlying osteoporosis to prevent further fractures
• Pain medication and activity modification as needed
• Vertebral augmentation (kyphoplasty) for painful compression fractures in selected patients

Surgery is considered for severe, rigid, or progressive curves, persistent pain not relieved by non-surgical care, neurological symptoms, or cosmetic and functional concerns that significantly affect quality of life. Procedures typically involve spinal instrumentation and fusion to correct and stabilize the curve.

When to see a specialist

See a spine specialist if you or your child has a visibly rounded back that is getting worse, persistent upper back pain, a sudden change in height or posture in an older adult (a possible fracture), or any new numbness, weakness, or trouble walking.