Kyphosis is a forward bending of the spine which produces a roundback curvature.
Looking at the spine from the side, the spine has three curvatures (cervical, thoracic and lumbar) that balance the head over the hips and pelvis. In most people the thoracic spine curvature is a gentle rounding of the upper back from the shoulders to the bottom of the ribcage known as thoracic kyphosis. There are opposite curves in the lower back called lumbar lordosis and in the neck called cervical lordosis. These three curvatures of the spine work together to balance the trunk and head over the pelvis.
A normal thoracic spine extends from the 1st to the 12th vertebra and there exists a wide range of “normal” thoracic kyphosis though most people have between 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called "hyperkyphosis".
Hyperkyphosis may be caused by an underlying structural abnormality in the bones of the spine (structural kyphosis) though also can be found in people without a structural cause known as postural kyphosis.
Postural kyphosis is a non-structural form of kyphosis that is commonly referred to as “poor posture.” The thoracic curvature in postural kyphosis is flexible meaning that it can be corrected by standing upright. The bony structures of the spine are normal and people rarely have symptoms. Back and core strengthening exercise and posture awareness is the main treatment for those with symptoms.
Structural kyphosis is caused by an abnormality in the bones of the spine that can occur prior to birth (in utero) or following birth during growth and development. It also can develop later in life due to degenerative changes from aging (kyphoscoliosis) or as the result of a traumatic injury or prior surgery (post-traumatic kyphosis).
If the spine does not form or segments don't separate properly in utero, it can become a sharp angulation that is visible by looking at the skin—called congenital kyphosis.
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Hyperkyphosis (forward bend of the thoracic [ribbed] vertebrae beyond normal limits) is classified as either postural or structural in origin.
Scheuermann’s kyphosis typically develops during the time of heavy adolescent bone growth: age 12 to 15 in boys or a few years earlier in girls; the back is stiff due to the abnormal shape of the vertebrae.
Post-traumatic kyphosis occurs most commonly in the thoracolumbar and lumbar regions (mid- to lower-back) after an injury.
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