Back Problem; Kyphosis
Your spine, or backbone, isn't completely straight. It curves slightly forward as it runs up your back. This gentle curve is normal, and it helps support your head and upper body.
For someone with kyphosis, which is sometimes called roundback or hunchback, the spine is curved too much, and it can cause discomfort or make it harder to breathe.
Usually, kyphosis doesn't lead to any problems and nothing needs to be done about it. But sometimes it can be serious enough that someone has to wear a back brace or have an operation.
What Is Kyphosis?
Kyphosis (say: ki-fo-sis) gets its name from a Greek word for bending forward, and that's what kyphosis is: too much forward bending, or rounding, of the spine. It's a fairly common condition for kids and grownups alike.
Your backbone isn't really a bone at all. It's many little bones, called vertebrae, all stacked up and held together by ligaments. The vertebrae in the middle and upper part of your back are attached to your ribs. These are the ones that are curved forward too much when someone has kyphosis.
There are different types of kyphosis that affect kids, and each has its own cause:
Postural kyphosis is the most common type of kyphosis, and it's rarely a problem. It's more common among girls than boys, and it happens when bones and muscles develop in an abnormal way as they grow, possibly because of slouching or poor posture. Kids may start to notice this kind of kyphosis as they get closer to being teenagers.
Scheuermann's kyphosis (named for a Danish doctor) also usually shows up as you get closer to your teen years. It causes vertebrae to look like wedges instead of rectangles when they're viewed from the side on X-rays. Scheuermann's kyphosis is slightly more common among boys than girls and can run in families.
Congenital kyphosis happens when the spine develops abnormally while a baby is still in its mother's womb. Several vertebrae can be fused together, or the bones can form improperly.
How Do Kids Find Out if They Have Kyphosis?
Sometimes kyphosis will be easy to see. A person with kyphosis might have a hump or have a back that looks more rounded than it should. Other cases of kyphosis will be harder to notice and may not be visible at all.
To check for kyphosis, a doctor will examine your spine and might ask you to do an easy test called the forward-bending test. It doesn't hurt, and all you have to do is bend forward at the waist. Often, kyphosis is easier to see when the back is bent this way. The doctor might also ask you to lie down, which can help with diagnosing postural kyphosis.
If it looks like you might have kyphosis, the doctor will order a set of X-rays to be taken of your spine. Looking at the X-rays can help a doctor determine which type of kyphosis you have.
To check if the kyphosis is affecting your breathing, the doctor may ask you to breathe while listening to your lungs. In some cases, if the doctor thinks kyphosis isn't the problem, he or she may call for an MRI (magnetic resonance imaging) scan of your back.
What if I Have it?
If it turns out that you have kyphosis, the doctor and your parent can talk about what to do next. If it seems like the rounding of your back isn't going to cause any problems, you may not need any treatment. You'll still have to get checkups until you're fully grown to make sure your back isn't curving more, but after that, kyphosis usually stops progressing.
In some cases, the doctor may send you to an orthopedist (say: or-tho-pee-dist), a back specialist who will examine your spine to determine the extent of your kyphosis and figure out what caused it.
With postural kyphosis, the doctor may prescribe physical therapy and strength training. Strong muscles are better at holding the spine in place. Sometimes an orthopedist will even suggest a firmer bed or lessons in good posture.
With Scheuermann's kyphosis, the orthopedist may recommend a brace to help support your back and keep the kyphosis from getting worse as your bones grow. In some severe cases, kyphosis has to be treated with an operation.
A brace can keep kyphosis from getting worse and support a person's back while he or she is growing, but it can't permanently fix kyphosis. The orthopedist will talk with you and your parent about what kind of brace will work best for you. Some braces are only worn at night. Others are meant to be worn day and night.
Doctors are making better braces for kids all the time. Braces keep getting lighter, more comfortable, and easier to wear. If you do have to wear a brace, it's important to wear it the way you're supposed to. Otherwise it won't work as well as it should.
After your spine is done growing, the kyphosis probably won't be a cause for concern and you won't have to wear a brace anymore.
Treating Kyphosis With Surgery
Most of the time, a brace will be enough to treat kyphosis. But somebody might need an operation for a severe case or for congenital kyphosis. Usually, it will be a surgery known as a spinal fusion. In this procedure, two or more of the affected vertebrae are fused, or joined together, to reduce the amount of rounding in the spine.
A kid having a back operation like this would be given anesthesia, a kind of medicine that puts patients to sleep and keeps them from feeling pain during an operation. Then the surgeon would attach new pieces of bone to the vertebrae by using metal rods, screws, and wire placed deep under the spine muscles. After a few months to a year, the bones grow together, or "fuse."
Once the bones have healed, the metal pieces aren't needed anymore, but they're not hurting anything. It would take another operation to get them out, so doctors usually leave them in place.
Years ago, before doctors started using metal rods, kids had to spend up to a year in a body cast as they recovered from spinal fusion. With modern surgery, kids can still move around as they recover. In fact, doctors often prescribe physical therapy as part of the recovery.
Every situation is different, but most kids who've had surgery to correct their kyphosis are up and walking within a day or two, and they can generally go home from the hospital within a week. Most will return to school within a month of the surgery and can resume some activities in 3 to 4 months.
By 6 to 12 months, most kids will be able to resume all routine activities, and the bones should be fully fused by about 1 year. It's important for kids who have had surgery to talk with their parents and the doctor about what activities are right for them as their backs heal.
Kids with kyphosis can lead active, normal lives and usually won't have any restrictions placed on them. Sports and activities don't make kyphosis worse, so even after surgery it's OK for kids to get out and play once they've talked with the doctor and a parent about how to participate safely.
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