Roundback

Alternative names
Scheuermann’s disease; Kyphosis; Hunchback; Postural kyphosis

Definition
Kyphosis is a curving of the spine that causes a bowing of the back, which leads to a hunchback or slouching posture.

Causes, incidence, and risk factors

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 the wedging together of several consecutive vertebrae (bones of the spine). The cause of Scheuermann’s disease is unknown.

In adults, kyphosis can be a result of osteoporotic compression fractures (fractures caused by osteoporosis), degenerative disease (such as arthritis), or spondylolisthesis (slipping of one vertebra forward on another).

Other causes of kyphosis include the following:

     
  • Infection (such as tuberculosis)  
  • Neurofibromatosis  
  • Connective tissue disorders  
  • Muscular dystrophy  
  • Spina bifida (a birth defect involving incomplete formation of part of the spine)  
  • Disk degeneration  
  • Certain endocrine diseases  
  • Paget’s disease  
  • Polio  
  • 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.

Symptoms

     
  • Mild back pain  
  • Fatigue  
  • Tenderness and stiffness in the spine  
  • Round back appearance  
  • Difficulty breathing (in severe cases)

Signs and tests

Physical examination by a health care provider confirms the abnormal curvature of the spine. The doctor will also look for any neurologic changes (weakness, paralysis, 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.

Occasionally, pulmonary function tests may be used to assess whether the kyphosis is affecting breathing.

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.  
  • Scheuermann’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 problems or pain, but the osteoporosis needs to be treated to help prevent future fractures. For debilitating deformity or pain, surgery is an option.  
  • Kyphosis caused by infection or tumor needs to be treated more aggressively, often with surgery and medications.

Treatment for other types of kyphosis depends on the cause. Surgery may be necessary if neurological symptoms develop.

Expectations (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  
  • Round back deformity

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.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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