Understanding kyphosis
Kyphosis is a condition of abnormal spinal curvature that causes a hunched or rounded upper back. While a slight forward curvature of the upper (thoracic) spine is normal, an excessive curve (over 50 degrees) is considered hyperkyphosis. Unlike postural kyphosis seen in adolescents, adult kyphosis is often more rigid and is a symptom of underlying health issues. This section breaks down the many contributing factors to adult kyphosis, explaining how and why these issues develop over time.
The role of degenerative disc disease
As we age, the intervertebral discs—the soft, gel-like cushions between each vertebra—undergo natural wear and tear. This process, known as degenerative disc disease, can lead to several changes that contribute to kyphosis:
- Disc flattening and shrinkage: Over time, discs lose water content, becoming thinner and flatter. This reduces the space between vertebrae, causing the spine to curve forward.
- Loss of shock absorption: The flattened discs are less effective at absorbing shock, placing more stress on the vertebrae and surrounding structures.
- Altered spinal alignment: The progressive collapse of the discs alters the overall alignment of the spine, contributing to the development of an excessive forward curve.
Osteoporosis and vertebral compression fractures
Osteoporosis, a condition causing weakened, porous bones, is one of the most common causes of adult kyphosis, particularly in women. The spine's vertebrae are especially vulnerable to the bone density loss associated with osteoporosis, which can lead to vertebral compression fractures. A compression fracture occurs when a vertebra collapses, often in a wedge shape. When multiple vertebrae collapse in this manner, the cumulative effect is a significant forward spinal curve, commonly known as a "dowager's hump".
Impact of poor posture
While poor posture is often associated with adolescent kyphosis, it can also play a role in the progression of the condition in adults. Years of slouching, whether at a desk or while standing, can lead to muscle imbalances and stretching of ligaments in the back. Over time, these habits reinforce the forward spinal curve, particularly in individuals with pre-existing degenerative conditions. Unlike more rigid, structural forms of kyphosis, postural kyphosis is more flexible and can often be managed with exercise and posture correction.
Less common but significant causes
Several other medical conditions can also contribute to the development of kyphosis in adulthood:
- Spine tumors and infections: Tumors growing on or near the spine can weaken or destabilize the vertebrae, causing them to collapse. Likewise, infections like tuberculosis can cause bone destruction in the spine.
- Connective tissue disorders: Conditions affecting connective tissues can impact the ligaments and other structures supporting the spine.
- Paget's disease: This condition involves abnormal bone destruction and regrowth, which can cause misshapen and weakened vertebrae.
- Neuromuscular disorders: Conditions that cause muscle weakness and loss of muscle tissue, such as muscular dystrophy or cerebral palsy, can affect the muscles that support the spine, leading to kyphosis over time.
- Previous spinal surgery: Kyphosis can sometimes occur as a complication following spinal surgery, especially if the fusion does not heal properly. This is known as iatrogenic kyphosis.
Comparison of adult kyphosis types
To better understand the different causes, here is a comparison of common types of adult kyphosis:
| Type of Kyphosis | Primary Cause | Key Characteristics | Common Age of Onset |
|---|---|---|---|
| Degenerative | Age-related wear and tear of spinal discs and joints | Gradual onset, often with chronic pain; typically involves lumbar spine | Most common in adults over 60 |
| Osteoporosis | Weakened bones and vertebral compression fractures | Progressive forward curve (dowager's hump); can cause significant height loss | Most common in postmenopausal women |
| Postural | Chronic poor posture and slouching habits | Flexible curve that corrects with effort; rarely causes pain | Can begin in adolescence but persists in adulthood |
| Post-Traumatic | Spinal injury or fracture | Can occur after a severe event like a car accident; can lead to nerve issues | Any age following trauma |
The importance of diagnosis and treatment
Timely and accurate diagnosis is critical for managing adult kyphosis and preventing its progression. A healthcare professional can perform a physical examination, review your medical history, and use diagnostic imaging like X-rays, MRIs, or CT scans to identify the root cause.
Treatment plans vary based on the underlying cause and severity. For many, conservative treatments are the first line of defense and can provide significant relief:
- Medications: Pain medication can help manage discomfort, while medications for osteoporosis can help slow bone loss and prevent future fractures.
- Exercise and physical therapy: A structured program can strengthen core and back muscles, improve flexibility, and help with postural correction.
- Bracing: In some cases, a brace may be used for pain relief, though it does not correct the curve in adults with rigid kyphosis.
For more severe or progressive cases, surgical correction may be necessary, particularly if the curvature is causing nerve compression, significant pain, or functional impairment.
Conclusion
Adult kyphosis is a multifaceted condition that can stem from various causes, with degenerative changes and osteoporosis being the most prevalent in older adults. While genetics and congenital factors can play a role, lifestyle factors like posture, injury, and underlying medical conditions are often significant contributors. By understanding what causes kyphosis in adults and seeking appropriate medical guidance, individuals can take proactive steps to manage their spinal health and improve their quality of life. For further resources, consult authoritative health websites such as the Hospital for Special Surgery.
