What is kyphosis?
Kyphosis refers to an abnormal increase in the forward rounding of the thoracic spine — the mid-back. While a normal thoracic spine has a natural gentle kyphosis of 20 to 40 degrees, pathological kyphosis exceeds this range and can cause pain, functional limitation, and progressive deformity.
Postural kyphosis — the most common type — develops from habitual poor posture and responds to physical therapy. Scheuermann's kyphosis is a structural deformity caused by abnormal vertebral growth during adolescence, producing a rigid forward curve that does not correct with position changes. Post-surgical kyphosis develops as a complication of prior spine surgery, particularly after laminectomy or inadequately balanced fusion.
Dr. Enguidanos is a fellowship-trained spine surgeon at HCA Florida Twin Cities Hospital in Niceville, Florida, with specialized training in spinal deformity correction including kyphosis surgery. He serves patients throughout the Florida Panhandle and Gulf Coast who have been told their deformity is too advanced for correction.
Common symptoms.
- Progressive forward-leaning posture or hunched appearance
- Mid-back pain, often worse with prolonged standing or sitting
- Fatigue from the muscular effort required to maintain upright posture
- Visible rounded back — more pronounced when bending forward
- Difficulty standing fully upright or looking straight ahead
- Chest tightness or shortness of breath in severe cases
- Leg pain or weakness if kyphosis causes spinal stenosis
- Loss of height over time with progressive deformity
What causes it.
- Postural — habitual slouching, most common in adolescents
- Scheuermann's disease — abnormal vertebral end plate development during growth
- Osteoporosis — vertebral compression fractures causing progressive forward collapse
- Post-surgical — inadequate sagittal balance after prior spine surgery
- Ankylosing spondylitis — inflammatory arthritis fusing the spine in a forward posture
- Neuromuscular conditions — muscle weakness allowing progressive kyphotic collapse
- Congenital — abnormal vertebral formation causing kyphosis from birth
When to call us.
Seek evaluation when kyphosis is progressing on serial X-rays, when pain is not responding to conservative treatment, when you have difficulty standing upright or your quality of life is significantly affected, or when you notice worsening posture despite physical therapy.
Scheuermann's kyphosis over 75 degrees in an adolescent or over 70 degrees with pain in an adult generally warrants surgical evaluation. Post-surgical kyphosis causing sagittal imbalance — where you cannot stand upright without bending your knees — requires prompt evaluation as it typically worsens over time without intervention.