Hyperkyphosis: definition, symptoms, causes, diagnosis and treatment

By Cristiano Antonino On May 10, 2023

Hyperkyphosis is a pathological accentuation of the physiological thoracic curvature of the spine

The term kyphosis indicates the physiological curve formed by the thoracic vertebrae

Also called pathological kyphosis, this disease has several causes.

It can arise due to poor posture or altered morphology of the vertebral bodies.

It is often related to ageing or congenital diseases.

The most common symptoms of this condition are back pain and stiffness, soreness in the spinal column area and easy fatigue.

The diagnosis is made through a thorough objective test and through imaging.

Treatment is dependent on the severity of the hyperkyphosis.

Hyperkyphosis: what is it?

Hyperkyphosis indicates the accentuation of the curvature of the spine in its thoracic section.

The term kyphosis indicates the anterior concavity of the thoracic vertebral tract in its lateral projection.

Excessive accentuation of this curvature is referred to as hyperkphosis.

Pathological kyphosis occurs when the angle of the curvature exceeds 45°.

Under normal conditions, the angle measures between 20° and 45°.

The causes of hyperkyphosis are numerous

This pathology is often linked to poor posture (this is why we talk about postural hyperkyphosis), but it can also be caused by morphological abnormalities of the vertebrae (Scheuermann’s hyperkyphosis) or abnormal development of the spine in intrauterine life (congenital hyperkyphosis).

Other causes are advanced age or spinal injuries.

In some cases, hyperclyphosis can be linked to other diseases such as osteoporosis, which makes the bones weaker and more prone to fractures, or spondylosis, a particular form of arthrosis, which deforms the intervertebral discs.

Other causes may be spina bifida, a morbid condition that causes abnormal development of the spine, Paget’s disease, which leads to weakening of the bones, and neurofibromatosis, a genetic disorder that affects the nervous system.

Finally, hyperkyphosis can be linked to muscular dystrophy, a genetic disease affecting the muscles, tuberculosis, a bacterial infection affecting the lungs, or tumours affecting the structures of the spine.

Hyperkyphosis: types and classification

Postural hyperkyphosis is caused by poor posture that causes a stretching of the ligaments and muscles that must support the thoracic vertebrae.

This causes a change in the physiological alignment of the thoracic vertebrae, permanently accentuating the anterior concavity that is formed by the thoracic section of the spine.

The condition is particularly prevalent among young people who have a spine that is easily shaped compared to that of an adult.

In fact, these patients often tend to have poor posture, overloading their backpacks, leaning their thoracic section against the back of a chair for many hours and standing with their arms hanging down.

Scheuermann’s hyperkyphosis is also known as juvenile kyphosis and is caused by an altered development of the vertebral bodies, which have a triangular-conical shape instead of a cylindrical-rectangular shape.

This disease is a form of osteochondrosis that affects the vertebrae and appears during childhood.

To date, the causes are still unclear, but some studies show that the origin could be multifactorial

Congenital hyperkyphosis occurs in patients who are born with a spine that has abnormal characteristics.

In particular, the abnormalities are caused by a fusion process between the vertebrae or a prenatal malformation in the vertebral bodies.

Despite various research studies, it is currently not possible to establish what causes these alterations in the intrauterine development of the spine.

Hyperclyphosis may also be linked to the natural ageing process.

Over the years, in fact, the spinal column undergoes morphological changes that can cause hyperclyphosis.

These changes are caused by alterations in the ligaments that support the vertebrae, a change in the muscular structure of the back or poor posture.

Hyperkyphosis: symptoms

Hyperkyphosis, when mild, may be asymptomatic, in other cases it presents signs such as pain and stiffness in the back and early muscle fatigue.

In more severe cases, the back muscles are subjected to severe stress that causes a continuous feeling of fatigue.

Hyperkyphosis, especially in young patients, is clearly visible due to the abnormal shape the back takes on.

Hyperkyphosis: possible complications

When the accentuation of the anterior concavity is large, numerous complications arise.

Patients often experience persistent pain that does not disappear even when taking pain-relieving medication.

The compression caused by the spinal column on the lungs can also cause breathing difficulties, while the crushing of nerve structures can lead to disturbances in impulse conduction.

Patients usually experience numbness, a sense of weakness in the arm or leg area, balance problems, and loss of control of bowel or bladder function.

In general, especially when it occurs in young patients and is clearly visible, hyperkinesis can also cause psychological disturbances, making acceptance of the condition and social relationships difficult.

How is hyperkinesis diagnosed?

Hyperclyphosis is diagnosed by means of a thorough objective examination and instrumental imaging tests such as X-rays, nuclear magnetic resonance imaging or CT scans.

Other investigative methods are used in special cases, for example when hyperkinesis is secondary to other diseases, such as tuberculosis or osteoporosis.

During the examination, hypercosis is assessed. The doctor carefully observes the patient’s spine, making him or her perform certain movements and assessing the patient’s response.

To complete the diagnosis, some diagnostic imaging tests are prescribed, such as x-rays, CT scans or nuclear magnetic resonance imaging (MRI). Thanks to these tests, it is possible to assess the characteristics and severity of hyperkyphosis.

Hyperkyphosis: assessment

During the examination, the degree of deformation of each vertebral body is also assessed.

This measurement is calculated by drawing two straight lines parallel to the vertebral plates on the X-ray plate.

The angle they form with each other is then measured.

The same procedure is applied to determine the global angle of the curve, which is useful for defining the degree of pathology, i.e. the angle formed by the tangents passing through the extremes of the curve.

In this case, the prolongation of the parallel lines should end up outside the X-ray plates.

Treatments and remedies for hyperkinesis

The treatment of hyperkinesis depends on the degree of accentuation of the curvature and the causes of the condition.

Mild hyperformities often require no treatment, while mild to moderate forms with correctable causes are treated by performing muscle-strengthening and posture-improving exercises, accompanied by the administration of painkillers.

In more severe cases of hyperkinesis, surgery may be required.

In any case, painkillers and physiotherapy exercises are helpful in reducing pain and also improve the appearance of the spine.

Surgery to treat hyperclyphosis, known as spinal fusion for kyphosis, allows the curvature to be corrected when it is too pronounced, reducing the risk of complications.

Surgery is only resorted to in the presence of severe forms of the condition.

This is because spinal fusion for kyphosis is a very complex and delicate operation that requires 4 to 8 hours in the operating theatre.

The surgeon fuses several vertebrae together, using bone grafts, screws and metal plates.

The aim is to recreate the normal curvature.

The operation is performed under general anaesthesia and requires hospitalisation for about a week, with the use of a brace for at least nine months.

In general, surgery is recommended by the doctor when the curvature of the thoracic section of the spine is very pronounced or in cases where it causes such intense pain that pain-relieving medication is ineffective.

Patients who have such a pronounced curvature that certain vital functions, such as breathing, are obstructed and who may have a worsening of the condition, also undergo the operation.

Particularly in younger subjects in whom the hypercosis is moderate, the use of a brace – also known as a shoulder straightener – can be helpful.

The purpose of this object is to prevent worsening of the curvature.