What is kyphosis?

Updated: May 04, 2020
  • Author: R Carter Cassidy, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Kyphosis refers to the normal apical-dorsal sagittal contour of the thoracic and sacral spine. Normal kyphosis is defined as a Cobb angle of 20-40° measured from T2 to T12. [1, 2]

As a pathologic entity, kyphosis is an accentuation of this normal curvature. Many potential etiologies of kyphosis have been identified. Kyphosis can occur as a deformity solely in the sagittal plane, or it can occur in association with an abnormality in the coronal plane, resulting in kyphoscoliosis. Although pathologic kyphosis can affect the cervical and lumbar spine as well the thoracic spine, cervical and lumbar involvement is uncommon; any kyphosis in these areas is abnormal.

Kyphosis can cause pain and potentially lead to neurologic deficit and abnormal cardiopulmonary function.  Multiple studies have confirmed that there is a linear relationship between a positive sagittal balance and increasing levels of pain, disability, and dysfunction. This disability is correctable with restoration of more normal sagittal alignment.

Indications for treatment include unremitting pain, neurologic changes, progression of deformity, and cosmesis. Medical therapy consists of exercise, medication, and bracing. Physical therapy may be of some benefit. Precise indications for surgical treatment of Scheuermann kyphosis remain to be defined but should be based on evaluation of global sagittal alignment and using standard indications for spine deformity.  

Surgical intervention for posttraumatic kyphosis is recommended if the patient's neurologic status changes, if the condition progresses, if the kyphosis is 30° or more, or if the loss of anterior vertebral height exceeds 50%. Contraindications for surgical treatment of kyphosis include a clinically significant cardiopulmonary risk and medical unfitness for surgery.

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