What Is Kyphosis? Symptoms, Causes and Treatment of a Rounded Back

Created: 06.09.2024 · Last Updated: 12.08.2026 · Category: Neurosurgery · Prepared by the Academic Hospital Web and Editorial Board.

What Is Kyphosis?

Kyphosis is the normal outward curvature of the thoracic spine when the body is viewed from the side.

When this rounding becomes greater than the expected physiological range, the condition may be described as hyperkyphosis. It can produce a noticeably rounded upper back.

The clinical importance of kyphosis depends on whether the curve is flexible or structural, its severity, whether it is progressing, the patient's age and growth status and whether pain or neurological symptoms are present.

Not every rounded-back appearance represents a structural spinal disorder. Postural kyphosis is usually flexible and may largely correct when the person stands upright. Structural conditions such as Scheuermann's kyphosis involve changes in vertebral shape and cannot simply be corrected by standing straighter.

What Is the Difference Between Normal Kyphosis and Hyperkyphosis?

The spine is not completely straight when viewed from the side.

The cervical and lumbar regions normally curve inward, while the thoracic region has a natural outward curve.

A thoracic kyphosis of approximately 20–45 degrees is commonly described as physiological, although normal measurements can vary with age, technique and individual anatomy.

An increased curvature can be classified as hyperkyphosis. The angle alone, however, does not determine whether treatment or surgery is necessary.

What Are the Types of Kyphosis?

Postural Kyphosis

Postural kyphosis commonly appears during adolescence. It is generally flexible and is not associated with major structural abnormalities of the vertebrae.

The curve can often improve significantly when the person stands upright or changes position.

Scheuermann's Kyphosis

Scheuermann's kyphosis is a structural spinal deformity that usually becomes apparent during adolescence.

Several vertebrae can become wedge-shaped as they grow, producing a stiffer and more pronounced curve.

Unlike postural kyphosis, the deformity does not fully correct simply by standing upright.

Congenital Kyphosis

Congenital kyphosis results from abnormal development of the vertebrae before birth.

Because some congenital curves may progress as the child grows, early specialist follow-up can be important.

Osteoporotic Kyphosis

In older adults, osteoporosis can cause vertebral compression fractures. Loss of height in the front of one or more vertebral bodies can progressively increase forward curvature of the spine.

Post-traumatic or Post-surgical Kyphosis

Structural kyphosis can also develop after spinal fractures, significant trauma or certain previous spinal operations.

What Causes Kyphosis?

Possible causes include:

  • Postural factors
  • Scheuermann's disease
  • Congenital vertebral abnormalities
  • Osteoporosis and vertebral compression fractures
  • Trauma
  • Age-related degenerative changes
  • Certain neuromuscular conditions
  • Previous spinal surgery

Prolonged slouched sitting can contribute to postural rounding, particularly in young people. However, structural conditions such as Scheuermann's or congenital kyphosis are not caused simply by poor posture.

What Are the Symptoms of Kyphosis?

Mild kyphosis may cause no symptoms.

Depending on the type and severity, symptoms can include:

  • A noticeably rounded upper back
  • Forward-rounded shoulders
  • Back pain
  • Muscular fatigue
  • Spinal stiffness
  • Tight hamstrings

Rarely, severe progressive curves can cause leg weakness, altered sensation, walking problems, bladder or bowel changes or breathing difficulty.

New leg weakness, walking difficulty, significant numbness or changes in bladder or bowel control alongside kyphosis require neurological assessment.

How Is Kyphosis Diagnosed?

Assessment begins with medical history and physical examination.

The examination can assess:

  • The spinal profile
  • Whether the curve is flexible or rigid
  • Shoulder and pelvic balance
  • Muscle strength
  • Sensation and reflexes
  • Walking

A forward-bend examination can make the contour of the spine easier to assess. The clinician may also assess whether the curve improves when the patient actively straightens or lies down.

X-rays

Standing spinal X-rays can be used to measure the kyphotic angle and assess vertebral shape.

In Scheuermann's kyphosis, structural wedging of consecutive vertebrae may be visible.

MRI and CT

MRI or CT is not necessary for every patient.

Additional imaging may be considered when there are neurological symptoms, congenital deformity, concern about neural compression, another structural abnormality or a need for surgical planning.

How Is the Kyphosis Angle Measured?

The degree of kyphosis is generally measured on a standing lateral X-ray using the Cobb method.

The clinician identifies reference vertebrae at the upper and lower ends of the curve and calculates the angle between them.

A high Cobb angle does not automatically mean that surgery is required. The same angle may have different clinical implications depending on age, curve type and symptoms.

How Is Kyphosis Treated?

Treatment depends on the type and magnitude of the curve, symptoms, age and remaining growth.

Options may include:

  • Observation
  • Exercise and physiotherapy
  • Bracing in selected patients
  • Pain management
  • Treatment of underlying osteoporosis or other conditions
  • Surgery for selected severe cases

Can Exercise Correct Kyphosis?

The effect of exercise depends on the type of kyphosis.

In postural kyphosis, back and core strengthening together with postural awareness can improve posture and symptoms.

In structural kyphosis such as Scheuermann's kyphosis, exercise can help pain, mobility, strength and functional posture but does not reverse the structural wedging of the vertebrae.

The goal of physiotherapy is not always to completely normalise the X-ray angle. Improving pain, mobility, muscular capacity and day-to-day function can also be important treatment goals.

When Is a Brace Used for Kyphosis?

Bracing can be considered particularly in skeletally immature children and adolescents with Scheuermann's kyphosis.

The decision depends on:

  • Curve magnitude
  • Whether the curve is progressing
  • Remaining growth
  • Pain and clinical findings

The type of brace and number of hours it should be worn are individually prescribed and require specialist follow-up.

When Is Surgery Considered for Kyphosis?

Most people with kyphosis do not need surgery.

Surgery may be considered for:

  • Severe progressive structural curves
  • Significant persistent pain despite non-operative management
  • Major functional impairment
  • Neurological compression
  • Severe deformity
  • Certain congenital forms of kyphosis

In Scheuermann's kyphosis, some specialist guidance considers surgery when curves exceed approximately 70–75 degrees, particularly when there is progression or significant pain. Other specialist sources particularly emphasise severe symptomatic curves of 80–90 degrees or more.

There is no universal angle at which every patient automatically requires surgery. Curve type and location, progression, age, growth, pain, neurological findings, functional impact and surgical risks are considered together.

How Is Kyphosis Surgery Performed?

For severe structural kyphosis, spinal fusion is one of the most commonly used procedures.

Screws and rods can be used to stabilise and gradually correct the spine. Rigid deformities may require osteotomy procedures to enable controlled correction.

How Are Kyphosis and Osteoporosis Related?

In older adults, increasing kyphosis can be associated with osteoporotic vertebral compression fractures.

Loss of height in the front of one or more vertebral bodies can progressively increase the forward curvature of the spine.

New height loss, increasing rounding of the back or sudden thoracic back pain in an older adult may warrant assessment for osteoporosis and vertebral fracture.

Treating osteoporosis does not necessarily reverse an established structural curve, but it can be important for reducing future fracture risk.

Can Kyphosis Be Prevented?

Not every form of kyphosis can be prevented. Scheuermann's kyphosis and congenital kyphosis cannot simply be prevented by maintaining better posture.

General measures that support spinal and bone health include:

  • Regular physical activity
  • Maintaining back and core strength
  • Avoiding prolonged static positions
  • Appropriate workplace ergonomics
  • Balanced nutrition
  • Adequate calcium and vitamin D intake
  • Avoiding smoking
  • Appropriate osteoporosis screening and treatment when indicated

Calcium or vitamin D supplements are not automatically required for everyone; supplementation should be based on diet, risk factors and clinical assessment.

When Should You See a Doctor?

Medical assessment is appropriate when:

  • A noticeable rounded back develops in a child or adolescent
  • The curve appears to be progressing
  • The curve does not improve when standing upright
  • Persistent back pain is present
  • An older adult develops height loss or increasing kyphosis
  • There is leg weakness or altered sensation
  • Walking becomes impaired

Have Your Spinal Curve Assessed

A rounded upper back, progressive postural change or persistent back pain can be assessed together with the type, degree and structural characteristics of the spinal curve.

Frequently Asked Questions

What is kyphosis?
Kyphosis is the natural outward curvature of the thoracic spine. When this curve increases significantly beyond the expected range, it may be described as hyperkyphosis and can produce excessive rounding of the upper back.
Can poor posture cause kyphosis?
Poor or prolonged slouched posture can contribute to postural kyphosis. Structural conditions such as Scheuermann's kyphosis and congenital kyphosis, however, are not caused simply by poor posture.
What is the difference between postural and Scheuermann's kyphosis?
Postural kyphosis is generally flexible and can substantially improve when a person stands upright. Scheuermann's kyphosis involves structural wedging of vertebrae, is more rigid and does not fully correct simply by standing straighter.
Can exercise completely correct kyphosis?
It depends on the type. Exercise and postural training can substantially improve postural kyphosis. In structural kyphosis such as Scheuermann's kyphosis, exercise can improve pain, movement and muscular capacity but does not reverse structural vertebral wedging.
Who may need a brace for kyphosis?
Bracing may be considered particularly for skeletally immature children or adolescents with appropriate Scheuermann's kyphosis. The decision depends on curve magnitude, progression and remaining growth and should be supervised by a specialist.
At what degree does kyphosis require surgery?
There is no single angle that automatically requires surgery in every patient. In Scheuermann's kyphosis, some specialist guidance considers surgical assessment for curves above approximately 70–75 degrees, but progression, pain, curve location, growth, neurological findings and functional impact must also be considered.
Can kyphosis cause shortness of breath?
Mild kyphosis usually does not affect breathing. Very severe kyphosis that significantly alters the chest wall can reduce the ability of the lungs to expand and may contribute to breathing difficulty.
Can osteoporosis cause a rounded back in older adults?
Yes. Osteoporosis can cause vertebral compression fractures. Loss of height in the front of one or more vertebrae can increase the forward curvature of the spine and lead to height loss and a more kyphotic posture.
Academic Hospital note: Kyphosis treatment should not be planned according to the curve angle alone. Whether the curve is postural or structural, progression, remaining growth, pain, neurological findings and its impact on daily function should be considered together. You can book an appointment.

References

  1. Academic Hospital. Kifoz Nedir? Belirtileri ve Tedavi Yöntemleri Nelerdir?
  2. American Academy of Orthopaedic Surgeons. Kyphosis (Roundback) of the Spine
  3. Scoliosis Research Society. Kyphosis
  4. Scoliosis Research Society. Scheuermann's Kyphosis
  5. NHS. Kyphosis