Ask the doctors: Hyperkyphosis symptoms range from pain to limb paralysis

Dear Doctor: I had scoliosis as a child, and now, at age 72, I’m living with kyphosis in my middle and upper back. It’s very painful, and I would like to know more about it.

Dear Reader: You’re referring to hyperkyphosis, also often referred to simply as kyphosis, a technical term for the natural and normal curvature of the upper back. Hyperkyphosis means that the curve has become abnormally amplified. It’s a condition in which the middle and upper portions of the spine develop an exaggerated forward curvature, which can cause the appearance of a rounded back. In more severe cases, hyperkyphosis results in visibly hunched posture, or what looks like a hump on the back.

The condition occurs because the thoracic vertebrae – or the middle portion of the back – have lost the rectangular shape that keeps the spine upright. Instead, they have become wedge-shaped, which causes the spine to have a forward arch. Kyphosis can be congenital, or present at birth. It may result from Scheuermann’s disease, a condition that can arise during the growth spurt of adolescence. It sometimes develops over time as the result of chronically poor posture. And it can be age-related, the result of osteoporosis or muscle weakness, or a combination of the two.

Due to the hormonal changes of menopause, which result in a decrease in bone density, age-related kyphosis is more common in menopausal and postmenopausal women than it is in older men. It happens because the specialized bone cells that form the hard, external surface of each vertebra can no longer renew at an optimal rate. This weakens the outside of the vertebra, and leaves the inner part, a more fragile structure that resembles a honeycomb, vulnerable to becoming “squeezed” or compressed.

Kyphosis can range from mild to severe. In less-serious cases, an individual may experience stiffness, pain and fatigue, but won’t necessarily have a visibly exaggerated spinal curve. Moderate cases of the condition may result in muscle weakness and decreased mobility. In more severe kyphosis, patients may suffer compression fractures in their vertebrae, which can cause the spine to collapse forward. Compression fractures can be caused by everyday activities such as lifting a bag of groceries, or even just twisting or coughing.

The condition is diagnosed with a physical exam and imaging tests. The spine’s natural curve ranges from 20 to 45 degrees. A curvature of more than 50 degrees results in a diagnosis of kyphosis. Treatment depends on the severity of the condition. Milder cases respond to the use of anti-inflammatories for pain and targeted exercise to improve posture and increase muscle strength. There is some evidence that exercises using a weighted backpack can be helpful. Although back braces may be used to relieve pain, they will not cause the adult spine to straighten.

Surgery for kyphosis is considered in severe cases only, such as when breathing is compromised, or when neurological symptoms, such as limb paralysis or weakness, develop. In those cases, spinal fusion may be recommended.