Pediatric Kyphosis

Kyphosis is a deformity of the backbone (spine). It is when the bones of the spine (vertebrae) in the upper back curve outward more than they should. A child with kyphosis has a back that is abnormally rounded or humpback. The condition is more common in girls than in boys.

A normal spine when looked at from behind appears straight. It can have a curve of 20° to 45° in the upper part of the back. With kyphosis, the curve can be 50° or more.

A child can be born with kyphosis. Or he or she can develop it because of other health reasons. These include:

• Metabolic problems
• Neuromuscular conditions
• Brittle bone disease (osteogenesis imperfecta), which causes bones to break easily
• Spina bifida
• Scheuermann disease, which causes the vertebrae to curve forward in the upper back

Kyphosis can also be caused by slouching. In such cases, it is called postural kyphosis. This is the most common type. It is often first noticed in the teen years.

These are the most common symptoms of kyphosis. Symptoms can occur a bit differently in each child. They can include:

• Difference in shoulder height
• The head bends forward compared with the rest of the body
• Difference in shoulder blade height or position
• Upper back looks higher than normal when the child bends forward
• Tight muscles in the back of the thigh (hamstring)

The symptoms of kyphosis may seem like other back problems. Or they may be a result of an injury or infection. Make sure your child sees his or her healthcare provider for a diagnosis.

Your child’s healthcare provider can diagnose kyphosis with a complete health history of your child, a physical exam and certain tests. He or she will want to know if there is any family history of kyphosis. He or she will also ask about developmental milestones since some types of kyphosis can be linked to other neuromuscular problems.

Your child may need these tests:

• X-rays. This test can make images of internal tissues, bones and organs. It can measure the angle of your child’s spinal curve. Treatment is often based on this measurement.
• Bone scans. This test can rule out any infection or broken bones in your child’s back.
• MRI. This test uses a combination of large magnets, radiofrequencies and a computer to make detailed images of organs and structures within the body. It can rule out any other problems of the spinal cord and nerves.
• CT scan. This test uses X-rays and a computer to make detailed images of the body.
• Blood tests

Finding kyphosis early is important for successful treatment. If the condition is left untreated, it can lead to problems with lung function. Healthcare providers, and even some school programs, routinely look for signs of kyphosis in children. Your child may need some other tests such as pulmonary function testing to see if there is any impact on your child's breathing.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

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

• Observation and repeated exams. Your child will need to see his or her healthcare provider regularly. Whether the curve gets worse depends on the amount of skeletal growth, or how skeletally mature your child is. Curving of the spine often slows down or stops after a child reaches puberty. Pain is commonly treated with over-the-counter medicines such as ibuprofen.
• Exercises. If your child’s kyphosis is because of slouching, certain exercises can fix his or her posture.
• Bracing. If your child is still growing, he or she may need a brace for some time.
• Surgery. In rare cases, your child may need surgery when the curve measures 75° or more and bracing has not slowed down the progression of the curve.