Kyphosis: Causes, Types, and Treatment of a Rounded Upper Back

Kyphosis is simply an over-rounded upper back. Some rounding of the upper spine is normal; when it becomes pronounced, it's called kyphotic — historically the "widow's hump." Most abnormal kyphosis falls into one of three categories, and the cause determines the treatment.

Congenital kyphosis

Present from birth, this comes from abnormal formation of the spine and can be progressive and severe, sometimes evolving rapidly in the first years of life. Mild forms may be watched; many require prompt, thorough evaluation and often surgical treatment, aimed at preventing progression of the curve. It can occur alongside scoliosis and various congenital syndromes affecting other bones and organs.

Scheuermann's disease

Here the vertebrae develop a wedge shape instead of the normal rectangular block, producing kyphosis. It's noted in adolescents, and treatment while a patient is still growing centers on bracing — which allows the growing spine to remodel and correct. In adults, a severe Scheuermann's kyphosis left over from adolescence can cause pain, progressive deformity, and neurological symptoms.

Fracture-induced kyphosis

The most common cause we see in adults. Spinal fractures — from trauma, but very often from osteoporosis, and sometimes from infection or tumor — typically collapse into a localized kyphosis, which can cause severe pain and, at times, neurological symptoms. Untreated or under-treated fractures can drive gradual, progressive deformity.

Treatment ranges from bracing and activity modification to surgical stabilization when conservative care fails. One important, relatively simple option deserves mention: vertebroplasty (and its relative kyphoplasty), in which stabilizing bone cement is injected into the fractured vertebra through a needle. In appropriately selected patients, it can relieve fracture pain markedly and help limit further collapse. (This is covered on our Low Back Pain and Nerve Blocks pages as well.)

Why kyphosis matters for pain

Beyond the deformity itself, a rounded upper back throws the whole posture forward, straining the chest and upper-back muscles and feeding the kind of chest-wall and upper-back pain covered on our chest and posture pages. And because osteoporosis-related compression fractures are such a common driver, treating kyphosis often means treating bone health too — calcium, vitamin D, weight-bearing exercise, and bone-strengthening medication where indicated.

If a rounding upper back is causing you pain, or you've had a spinal compression fracture, call Newport Pain Management at (949) 759-8400 — there's more that can be done than bracing alone.