Kyphosis Correction Surgery

Kyphosis is an excessive forward curvature of the spine that gives the upper back a rounded or hunched appearance. A gentle forward curve is normal in the thoracic spine; kyphosis is when that curve becomes more pronounced than it should be. Many people have mild kyphosis that needs no treatment, but a severe, rigid, or progressive curve can cause pain, imbalance, and — in the most serious cases — pressure on the spinal cord, and may need surgical correction.

What it is

Kyphosis correction surgery realigns an abnormally rounded spine and holds it in a balanced position. The spine is straightened as far as is safe and stabilised with rods and screws, supported by bone graft so that the corrected segment fuses solidly over time.

The right operation depends on the flexibility of the curve. A flexible curve can often be corrected with instrumentation alone. A rigid or sharply angled curve does not straighten on its own and needs bone to be removed — an osteotomy — to let the spine hinge into a better position. The most severe, rigid, angular deformities may require removal of an entire segment of the spinal column.

Who is a candidate? (Indications)

Surgical correction is considered for carefully selected patients, typically those with:

• A severe curve that is causing pain, stiffness, or a disabling deformity
• A curve that is progressing despite bracing or non-surgical treatment
• Loss of balance, where the head and trunk are carried too far forward
• Sharp, angular kyphosis from old infection, trauma, or congenital malformation
• Neurological symptoms — leg weakness, numbness, or balance problems — from pressure on the spinal cord

The cause and shape of the curve, the patient’s age and general health, and the balance of risk and benefit all inform the decision.

How it is performed

The operation is planned in detail beforehand, often with full-length standing X-rays and three-dimensional reconstruction of the anatomy. In broad terms:

1. The spine is exposed through a posterior (back) approach.
2. Screws and rods are placed above and below the abnormal segment to control the spine.
3. Where the curve is rigid, a measured wedge of bone (an osteotomy) — or, in the most severe cases, a whole segment of the spinal column — is removed.
4. The spine is realigned into a balanced position around the protected spinal cord.
5. The correction is held with rods and screws, and bone graft is added to achieve a solid fusion.

Throughout, continuous spinal-cord monitoring gives early warning of any threat to neurological function so the team can respond immediately.

Benefits and risks

The benefits of correction are a more balanced, upright spine, relief of pain caused by the deformity, prevention of further progression, and — where the cord is under pressure — protection of neurological function. Against these must be weighed the real risks of major spinal surgery: injury to the spinal cord or nerves, significant blood loss, infection, implant problems, incomplete correction, and the possibility of further surgery, as well as the general risks of prolonged anaesthesia. These are discussed openly and individually so that the expected benefit clearly justifies the risk for that particular patient.

Alternatives

For milder or non-progressive kyphosis, alternatives include observation with periodic imaging, physiotherapy to improve posture and strength, pain management, and — in growing children with certain conditions — bracing. Where kyphosis follows an osteoporotic fracture, treating the underlying bone fragility is an important part of care. A specialist assessment helps determine whether surgery is genuinely necessary, and if so, whether a smaller procedure will suffice.

Dr. Garg’s approach & experience

Dr. Garg is Principal Director & Head, Orthopaedics & Spine at Max Hospital, Delhi, and a former Professor at AIIMS New Delhi, with more than 325 peer-reviewed publications. Severe and rigid kyphosis often requires osteotomies or, in the most demanding cases, removal of an entire segment of the spinal column.

For the most severe, rigid deformities, Dr. Garg developed a Modified Posterior Vertebral Column Resection (Modified PVCR), refined at AIIMS and published in The Spine Journal in 2020 with the aim of making this exceptionally demanding operation safer and more reproducible. This sits within a broader body of deformity work that also includes research into robotic, navigated, and 3D-printed patient-specific approaches.

When to seek a specialist opinion

A specialist assessment is appropriate for a kyphosis that is severe, visibly worsening, causing persistent pain or a forward-leaning posture, or following a known vertebral fracture. Any kyphosis associated with leg weakness, numbness, balance problems, or changes in bladder or bowel function should be reviewed promptly.