Kyphosis

Hyperkyphosis is an excessive roundness or a hump in the middle of the back.

Many teenagers slouch and look like they might have a hump, but this is not hyperkyphosis. If you ask them to stand up straight, the hump may disappear. Some doctors call this slouching “postural roundback.” Postural roundback is more common in girls than in boys.

Poor posture often worries parents, but it has not been shown to lead to any permanent back deformity.

In some rare cases, the bones of the back (vertebrae) do not grow correctly. In Scheuermann kyphosis, the front part of the vertebrae does not grow as well as the back part.

As your child approaches the teenage years, their back may become more curved and humped. Because the spine grows fast during these years, the vertebrae’s uneven growth can quickly lead to a deformity. The deformity, however, is rarely bad enough to require surgery.

Scheuermann kyphosis is about twice as common in boys as it is in girls.

Babies can be born with kyphosis. When the condition is present at birth (congenital), the bones in the back are shaped like wedges instead of the normal, round block shape. This may cause the spine to bend sharply.

In serious cases, the sharp bend in the spine can press on the spinal cord and cause paralysis of the legs. Young children or babies with congenital scoliosis have a higher risk of developing spinal cord problems.

• The Spine Program team includes doctors, surgeons, physician assistants and nurse practitioners from Orthopedics and Sports Medicine. For more severe curves that affect the spinal cord, our orthopedic specialists work with experts from Neurosciences.
• We offer your child the support of an entire medical center. Based on your child’s needs, we involve specialists from other areas of Seattle Children’s, such as Rehabilitation Medicine.
• Nonsurgical treatment commonly means physical therapy or a back brace. We have the largest team of physical therapists in the Pacific Northwest who specialize in the care of babies, children, teens and young adults. We also have onsite orthotists to build and fit braces for our young patients.
• If your child needs surgery, our pediatric orthopedic surgeons have expanded fellowship training in spine problems.

• Babies, children and teens are still developing. When we evaluate your child’s kyphosis, design their treatment and provide their care, we carefully consider how growth may affect your child’s spinal curve over time — and how their spinal curve may affect the rest of their development and health.
• Our experts are skilled in treating the youngest patients, including babies with congenital kyphosis, through young adults.
• We have the largest group of board-certified pediatric radiologists in the Northwest. If your child needs imaging that uses radiation, we use the lowest amount possible (PDF) to produce the best image.

• Before recommending any surgery, we look at your child as a whole person and take into account many factors, including the degree of their spinal curve, the effects on their health, their remaining growth and what results you can expect from treatment.
• Our surgical spinal cord monitoring team leads the country in developing new techniques for making back surgery safer. We have developed recent advances in spinal cord monitoring and treatment of scoliosis in very young children. Neuromonitoring helps us prevent a spinal cord injury during surgery.
• We have the technology and expertise to precisely place hardware, such as rods and screws, in your child’s spine, including with CT (computed tomography)–guided surgery.

• Your child’s team works together not only to plan and provide care for your child, but also to make sure you and your child understand your child’s condition and treatment options.
• Coordination is easier for you because your team members from the Spine Program work closely with each other and with other specialized programs and clinics your child may need at Seattle Children’s.
• We support your family with a range of resources, such as Child Life specialists, the Family Resource Center and Guest Services.

In mild cases of Scheuermann kyphosis, exercises to strengthen the back can relieve the pain and tiredness that sometimes comes when children are active. Studies have not shown that exercises affect the growth or development of the spine, though.

If your child is still growing and has a mild case of Scheuermann kyphosis, wearing a back brace may stop the curve from getting worse. Our experienced team makes braces for children of all sizes and ages. Read about braces and our other orthotics and prosthetics services.

If your child has more severe kyphosis – a curve of 75 degrees or greater – we offer surgery to correct their curve and stabilize their spine.

In this surgery, the doctor will: 

• Anchor screws or hooks to the bones in your child’s spine (vertebrae).
• Attach the screws or hooks to a metal rod, and straighten the back.
• Fuse the spine by removing the joints between the bones.
• Place a bone graft next to the spine to help the bones grow together. 

In severe cases, we use thoracoscopic techniques to release ligaments at the front of the spine, making your child’s spine more flexible.

In this surgery, the doctor will:

• Use special equipment to view the procedure on a monitor.
• Correct the spine deformity by inserting tiny instruments into your child’s chest through small cuts (incisions).

To treat congenital kyphosis, doctors often:

• Remove the problem vertebrae to relieve pressure on the spinal cord that can cause paralysis.
• Correct the problem using metal rods and screws or hooks, as described earlier.

Children with congenital kyphosis who have surgery have a chance of developing problems with their nervous systems. As a result, we make sure your child’s multidisciplinary team includes experienced doctors from Neurosurgery to ensure the best possible results.