Kyphosis: Causes, Diagnosis & Treatment Options

Kyphosis is an excessive forward curve of the upper back that gives the spine a rounded or hunched appearance. A gentle outward curve in this region is normal; the term kyphosis is used when that curve becomes greater than expected. This page explains the main types, how kyphosis is assessed, and the range of non-surgical and surgical options.

What is kyphosis?

The spine has natural front-to-back curves that balance the body and absorb load. The thoracic (chest) region curves gently outward, while the neck and lower back curve inward. Kyphosis refers to an exaggerated outward curve, most often in the thoracic spine, which makes the upper back look rounded.

A modest thoracic curve is healthy. When the curve is more pronounced than the normal range, it may be described as hyperkyphosis or, in everyday language, roundback. Whether this matters depends on the size of the curve, whether it is fixed or flexible, the underlying cause, and the symptoms it produces.

Which parts of the spine are affected?

Kyphosis most commonly affects the thoracic spine — the twelve vertebrae of the upper and mid-back that connect to the ribs. This is the region where an outward curve is normal, so it is also where excessive curvature is most often seen.

Less commonly, abnormal kyphosis can develop at the junction between the thoracic and lumbar spine, or affect the cervical (neck) region as a loss of its usual inward curve. The location and shape of the curve guide both diagnosis and management.

Types of kyphosis

Several distinct patterns exist, and distinguishing between them is central to treatment:

• Postural kyphosis is a flexible, correctable rounding usually related to habitual posture. The bones are normal, and the curve straightens when the person stands tall or lies down.
• Scheuermann’s kyphosis is a structural form that typically develops during adolescence. The front of several vertebrae grows less than the back, giving them a wedge shape, which produces a fixed, more angular curve.
• Osteoporotic (age-related) kyphosis develops when weakened vertebrae sustain small compression fractures, causing the front of the bones to collapse and the upper back to round forward over time.
• Congenital kyphosis is present from birth due to abnormal formation of the vertebrae.
• Secondary kyphosis can follow injury, infection, previous surgery, or other spinal conditions.

Causes and risk factors

The cause depends on the type. Contributing factors include:

• Habitual posture, which underlies flexible postural kyphosis, often in adolescents and young adults.
• Abnormal vertebral growth during adolescence, as seen in Scheuermann’s kyphosis; its precise cause is not fully understood.
• Osteoporosis, where reduced bone density allows vertebral compression fractures, an important cause in older adults and especially post-menopausal women.
• Degenerative changes of the discs and joints with age.
• Injury to the vertebrae from trauma.
• Congenital malformation, infection such as spinal tuberculosis, or previous spinal surgery.

Symptoms and warning signs

Many people with mild kyphosis have few symptoms beyond the visible curve. When symptoms occur, they may include:

• A visibly rounded or hunched upper back.
• Stiffness and reduced flexibility of the upper spine.
• Aching or pain in the back, sometimes worse with prolonged standing or activity.
• Fatigue of the back muscles.
• A gradual loss of height, particularly with osteoporotic curves.

Red-flag warning signs that need prompt medical attention include weakness, numbness or tingling in the arms or legs; problems with balance or walking; loss of bladder or bowel control; severe or rapidly worsening pain; pain with fever or unexplained weight loss; or breathlessness with a very severe curve. These features may indicate pressure on the spinal cord, infection, or another serious cause and should not be ignored.

How kyphosis is diagnosed

Assessment begins with a clinical history and physical examination. The clinician observes the spine from the side and asks the person to bend forward, which helps show whether the curve is flexible or fixed and whether it is smoothly rounded or sharply angular. Neurological function in the limbs is checked.

Imaging confirms the diagnosis and measures the curve:

• X-rays of the spine, taken from the side, are the main tool. The curve is measured in degrees, and the shape of individual vertebrae can reveal wedging, fractures or other changes.
• MRI may be used if there is concern about the spinal cord, nerves, discs, infection or a tumour.
• CT can provide detailed bone images, particularly before surgery or for congenital problems.
• EOS or full-length standing imaging allows the whole spine to be assessed in its natural standing posture with a low radiation dose.
• Bone density testing is often arranged when osteoporosis is suspected.

Non-surgical treatment

Most kyphosis is managed without surgery. The approach is tailored to the type, severity and symptoms:

1. Observation with periodic review is appropriate for mild or non-progressive curves, especially to monitor change during growth.
2. Physiotherapy and exercise focus on posture, core and back strengthening, and flexibility. These help with comfort and function and can address the postural component of a curve.
3. Bracing may be recommended for growing adolescents with Scheuermann’s kyphosis, where it can help guide the spine while the skeleton is still maturing.
4. Pain management, including simple analgesia where appropriate and activity modification, supports daily function.
5. Treating the underlying cause, such as managing osteoporosis with bone-protective treatment, is important in age-related kyphosis to reduce the risk of further fractures and progression.

When surgery is considered

Surgery is reserved for a minority of people and is considered only when there is a clear indication. These may include a severe or progressive curve, significant pain not relieved by conservative care, neurological symptoms from pressure on the spinal cord, or, rarely, effects on breathing.

The aim of surgery is to reduce the curve to a safer, more balanced position and to stabilise the spine, typically using a spinal fusion with instrumentation. The specific procedure depends on the cause, the flexibility of the curve and the person’s overall health. As with any major surgery, the decision involves weighing the potential benefits against the risks, and is made jointly between the person and their surgical team.

Recovery and outlook

The outlook varies with the type and cause. Postural kyphosis generally responds well to posture and exercise programmes. Scheuermann’s kyphosis is often stable into adulthood, with many people managed conservatively and a smaller number benefiting from bracing or surgery. Osteoporotic kyphosis outcomes depend on controlling the underlying bone disease and preventing further fractures.

After surgery, recovery is gradual and structured, with a graded return to activity guided by the surgical team. Outcomes depend on many individual factors, and this page does not predict results for any one person.

When to see a spine specialist

It is reasonable to seek specialist assessment if you or a family member has a visibly worsening roundback, a curve that is rigid rather than flexible, back pain that limits daily life, or a sharp angular deformity. Older adults noticing progressive rounding or height loss should be evaluated for osteoporosis and vertebral fractures.

Seek urgent medical care if you develop any red-flag features, such as limb weakness or numbness, walking or balance problems, loss of bladder or bowel control, or severe pain with fever or weight loss. A spine specialist can confirm the type of kyphosis, explain whether treatment is needed, and outline the appropriate options.