A normal spine, when viewed from behind appears straight. However, a spine affected by kyphosis shows evidence of a forward curvature of the vertebrae in the upper back area, giving the child an abnormally rounded or "humpback" appearance. Children whose curvature exceeds a limited range of variation - curving forward in a “C” shape- will require medical attention and may be diagnosed with kyphosis. Together with scoliosis, another type of curvature, this condition comprises a significant proportion of spinal deformity diagnoses seen by pediatric orthopedists.
Dr. Munish Gupta joins the show to discuss the importance of early detection, treatments, and follow-up care for children diagnosed with kyphosis.
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Kyphosis in the Pediatric Patient
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Learn more about Munish Gupta, MD
Munish Gupta, MD
Munish Gupta, MD specializes in adult and pediatric spine surgery, with a focus on complex spinal reconstructive surgery for treatment of all spinal deformities of the lumbar, thoracic and cervical regions. He has over 23 years of experience in treating spinal deformities such as scoliosis, kyphosis, spondylolisthesis and Flatback syndrome. Dr. Gupta also specializes in spinal revision surgery and spinal tumors.Learn more about Munish Gupta, MD
Transcription:
Melanie Cole (Host): As a provider, you may have heard parents express concern over their child’s posture and healthy spine development. I know as a parent; I was concerned about that myself. Today, we’re talking about kyphosis. My guest is Dr. Munish Gupta. He’s a Washington University pediatric orthopedic surgeon at St. Louis Children’s Hospital. Dr. Gupta, always a pleasure. Thank you so much for joining us again. What is kyphosis?
Munish Gupta, MD (Guest): Good morning. Great to talk to you again Melanie. Kyphosis is a round back. So, as you know, we have the lumbar curve which is like a sway back and then the thoracic curve, which is your chest, it kind of protrudes backwards. And when it protrudes abnormally backwards; it’s called a round back or a kyphotic spine or if it’s really severe and sharp; people often refer to it as like a hunchback if you remember the Hunchback of Notre Dame, but that’s quite severe. That’s what kyphosis is.
Host: Dr. Gupta, people would tend to think of that posture, that position as something that happens in the elderly, in women with osteoporosis or in very old men. But this is something that can happen in children. Do we know why it would happen in a child?
Dr. Gupta: So, what you see in elderly women is osteoporosis and this round back kyphosis often you see in the grocery stores. But in children, there are like basically three different causes of kyphosis. One is postural and the way you differentiate that is because when you tell the child he’s slouching or having a bad posture, straighten out and they can straighten out. So, it’s very flexible.
Then there’s the other kinds which are Scheuermann’s Kyphosis. Scheuermann’s Kyphosis was actually first described by a Danish radiologist; that’s why the name Scheuermann’s and that is more of a ridged kyphosis. So, the patient is not able to correct that kyphosis. It is sort of built into their spine. And the last one is congenital kyphosis, and these tend to be more sharp and angular and they are from the abnormal vertebral bodies that are formed in utero. So, those are the basic three different kinds of kyphosis.
Host: So, then, what are the warning signs that a pediatrician can look out for when they are seeing patients? Is that who would do a sort of a spine check and what should they be looking for and what should parents keep an eye out for?
Dr. Gupta: Yes, I think some of the things that you should be looking for is this rounded shoulder posture with a visible sort of hump for lack of a better word and then having pain in their back in the thoracic region, fatigue, stiffness of their spine and their muscles are getting tight in their hamstrings and sometimes they even develop tingling and pain in the legs with numbness or loss of sensation which is more likely to be congenital kyphosis.
So, any kind of things like that, the parents should look for and the doctor should look for in their examination of the patient.
Host: So, important. So, then how do you diagnose it? And is it something Dr. Gupta that once you have determined that this is happening; are there fixes? Is it reversible or is it inevitable?
Dr. Gupta: So, I think the first thing is physical examination and the history. So, you look at the patient. You see if there is a flexible spine like in postural kyphosis. See if it is a ridged spine and then if it is a sharp angular spine, those are keys of the things I told you about just now. And then you get some x-rays. That’s the basics, right. So, if you look at the x-rays, you see that there are no vertebral anomalies and it is a pretty flexible kyphosis; rather than Scheuermann’s. With Scheuermann’s Kyphosis, you see that the vertebral body endplates where the discs are, they are very abnormal, and the bodies are shaped more like a triangular body rather than a rectangular body. So, that’s more Scheuermann’s.
And then the congenital kyphosis is very apparent because you have very abnormal formed vertebral bodies. So, that’s the basic things and if they are having trouble breathing, then you might want to get some pulmonary function tests because if the kyphosis gets severe enough; it can affect your lungs in a restrictive manner. And the other thing is that if they are having symptoms of tingling down their legs or weakness; then I think an MRI or a magnetic resonance imaging of their spinal cord in the thoracic spine would be very useful.
Host: And what are some treatment options once you’ve determined what’s going on? What are you looking to do?
Dr. Gupta: So, I think it kind of depends on the diagnosis. So, if it’s more of a postural kyphosis and it’s not very severe and it’s flexible; I think observation which means you monitor it and then physical therapy to strengthen their extensor muscles and core exercises to help them. But if that’s not helpful; then bracing is always an option even in Scheuermann’s disease when the kyphosis is more than 60-65 degrees you think about bracing especially if it is not flexible. And this is temporary until the patient is done growing. Once they are done growing, the brace can come off.
But then if the curvature is so severe that it’s not amenable to bracing, more than 70-75 degrees; you want to think about reducing the curvature. You want to prevent the progression of the curvature. You want to maintain the improvement of the curvature that you do with surgery and also alleviate some of the back pain that’s commonly associated with Scheuermann’s disease. When you correct the kyphosis and you fuse them; usually their pain improves.
Host: So, what’s the long term outlook and prognosis for someone, whether you’ve done the bracing and you’ve tried these treatments, then what are you looking for as they become teenagers and even into adulthood?
Dr. Gupta: If their kyphosis does not get worse enough to require surgery; then you can observe them and then you can observe them periodically after five to ten years, every five to ten years to look to make sure that it’s not getting worse. Because it’s not going to get worse as quickly when you are growing fast as in a pubertal growth spurt. But you can get worse over time if you have a significant kyphosis. So, you monitor them with x-rays and then if they are having trouble breathing, you can do pulmonary function tests.
But once you have treated them with let’s say a severe curve with a fusion, then you monitor them every five to ten years to make sure they are not having problems below the area of fusion of there’s not a problem in the fusion itself meaning that it didn’t heal properly. But overall, these patients do quite well. They don’t do as badly as somebody with a severe scoliosis. They have more of a restrictive pulmonary disease than these patients typically.
Host: So, what else would you like a referring physician to know Dr. Gupta about the Pediatric Orthopedic Program at St. Louis Children’s Hospital?
Dr. Gupta: So, I think the doctors and the patients should know that first you look out for these symptoms and also the posture of your child, is the rounded shoulders, the visible hump on the back, back pain, stiffness in their legs and hamstrings and then also any danger signs of weakness and numbness and tingling down the legs or loss of sensation. I mean these are signs that you need to get taken care of with at least starting with an x-ray and then if they are really having neurologic symptoms, get MRIs and then refer on to the experts. At St. Louis Children’s Hospital we have an excellent spinal deformity program and we can help further evaluate the child and give you a plan.
Host: And it’s really great information. Do you have any final thoughts on the topic today, Dr. Gupta, on kyphosis itself and what you’d like other providers to know about identifying it and seeking out treatment?
Dr. Gupta: Yes. First of all, I think a basic. Scoliosis is side to side curvature; kyphosis is more of a rounding back. That’s number one. And number two, just because you have kyphosis doesn’t mean it’s the end of the world. People do quite well with it, and it doesn’t develop into severe condition; they have a pretty good life with it. The natural history is quite benign. But if they do develop a significant problem, they can be fixed with a fusion and they have a quite excellent results. And then the congenital is probably the worst one. That is something you don’t want to ignore and prevent neurologic damage and severe deformity from happening. So, those are the things that I would like to stress.
Host: Thank you so much again Dr. Gupta for joining us. It is a pleasure as always to have you as a guest and sharing your expertise. Thank you again.
And that wraps up this episode of radio rounds with St. Louis Children’s Hospital. To consult with a specialist or to learn more about services and resources available at St. Louis Children’s Hospital, please call the Children’s Direct Physician Access Line at 1-800-678-HELP. Or you can head on over to our website at www.stlouischildrens.org for more information and to get connected with one of our providers. If you as a provider found this podcast informative, please share with other providers, share on your social media and be sure not to miss all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.
Melanie Cole (Host): As a provider, you may have heard parents express concern over their child’s posture and healthy spine development. I know as a parent; I was concerned about that myself. Today, we’re talking about kyphosis. My guest is Dr. Munish Gupta. He’s a Washington University pediatric orthopedic surgeon at St. Louis Children’s Hospital. Dr. Gupta, always a pleasure. Thank you so much for joining us again. What is kyphosis?
Munish Gupta, MD (Guest): Good morning. Great to talk to you again Melanie. Kyphosis is a round back. So, as you know, we have the lumbar curve which is like a sway back and then the thoracic curve, which is your chest, it kind of protrudes backwards. And when it protrudes abnormally backwards; it’s called a round back or a kyphotic spine or if it’s really severe and sharp; people often refer to it as like a hunchback if you remember the Hunchback of Notre Dame, but that’s quite severe. That’s what kyphosis is.
Host: Dr. Gupta, people would tend to think of that posture, that position as something that happens in the elderly, in women with osteoporosis or in very old men. But this is something that can happen in children. Do we know why it would happen in a child?
Dr. Gupta: So, what you see in elderly women is osteoporosis and this round back kyphosis often you see in the grocery stores. But in children, there are like basically three different causes of kyphosis. One is postural and the way you differentiate that is because when you tell the child he’s slouching or having a bad posture, straighten out and they can straighten out. So, it’s very flexible.
Then there’s the other kinds which are Scheuermann’s Kyphosis. Scheuermann’s Kyphosis was actually first described by a Danish radiologist; that’s why the name Scheuermann’s and that is more of a ridged kyphosis. So, the patient is not able to correct that kyphosis. It is sort of built into their spine. And the last one is congenital kyphosis, and these tend to be more sharp and angular and they are from the abnormal vertebral bodies that are formed in utero. So, those are the basic three different kinds of kyphosis.
Host: So, then, what are the warning signs that a pediatrician can look out for when they are seeing patients? Is that who would do a sort of a spine check and what should they be looking for and what should parents keep an eye out for?
Dr. Gupta: Yes, I think some of the things that you should be looking for is this rounded shoulder posture with a visible sort of hump for lack of a better word and then having pain in their back in the thoracic region, fatigue, stiffness of their spine and their muscles are getting tight in their hamstrings and sometimes they even develop tingling and pain in the legs with numbness or loss of sensation which is more likely to be congenital kyphosis.
So, any kind of things like that, the parents should look for and the doctor should look for in their examination of the patient.
Host: So, important. So, then how do you diagnose it? And is it something Dr. Gupta that once you have determined that this is happening; are there fixes? Is it reversible or is it inevitable?
Dr. Gupta: So, I think the first thing is physical examination and the history. So, you look at the patient. You see if there is a flexible spine like in postural kyphosis. See if it is a ridged spine and then if it is a sharp angular spine, those are keys of the things I told you about just now. And then you get some x-rays. That’s the basics, right. So, if you look at the x-rays, you see that there are no vertebral anomalies and it is a pretty flexible kyphosis; rather than Scheuermann’s. With Scheuermann’s Kyphosis, you see that the vertebral body endplates where the discs are, they are very abnormal, and the bodies are shaped more like a triangular body rather than a rectangular body. So, that’s more Scheuermann’s.
And then the congenital kyphosis is very apparent because you have very abnormal formed vertebral bodies. So, that’s the basic things and if they are having trouble breathing, then you might want to get some pulmonary function tests because if the kyphosis gets severe enough; it can affect your lungs in a restrictive manner. And the other thing is that if they are having symptoms of tingling down their legs or weakness; then I think an MRI or a magnetic resonance imaging of their spinal cord in the thoracic spine would be very useful.
Host: And what are some treatment options once you’ve determined what’s going on? What are you looking to do?
Dr. Gupta: So, I think it kind of depends on the diagnosis. So, if it’s more of a postural kyphosis and it’s not very severe and it’s flexible; I think observation which means you monitor it and then physical therapy to strengthen their extensor muscles and core exercises to help them. But if that’s not helpful; then bracing is always an option even in Scheuermann’s disease when the kyphosis is more than 60-65 degrees you think about bracing especially if it is not flexible. And this is temporary until the patient is done growing. Once they are done growing, the brace can come off.
But then if the curvature is so severe that it’s not amenable to bracing, more than 70-75 degrees; you want to think about reducing the curvature. You want to prevent the progression of the curvature. You want to maintain the improvement of the curvature that you do with surgery and also alleviate some of the back pain that’s commonly associated with Scheuermann’s disease. When you correct the kyphosis and you fuse them; usually their pain improves.
Host: So, what’s the long term outlook and prognosis for someone, whether you’ve done the bracing and you’ve tried these treatments, then what are you looking for as they become teenagers and even into adulthood?
Dr. Gupta: If their kyphosis does not get worse enough to require surgery; then you can observe them and then you can observe them periodically after five to ten years, every five to ten years to look to make sure that it’s not getting worse. Because it’s not going to get worse as quickly when you are growing fast as in a pubertal growth spurt. But you can get worse over time if you have a significant kyphosis. So, you monitor them with x-rays and then if they are having trouble breathing, you can do pulmonary function tests.
But once you have treated them with let’s say a severe curve with a fusion, then you monitor them every five to ten years to make sure they are not having problems below the area of fusion of there’s not a problem in the fusion itself meaning that it didn’t heal properly. But overall, these patients do quite well. They don’t do as badly as somebody with a severe scoliosis. They have more of a restrictive pulmonary disease than these patients typically.
Host: So, what else would you like a referring physician to know Dr. Gupta about the Pediatric Orthopedic Program at St. Louis Children’s Hospital?
Dr. Gupta: So, I think the doctors and the patients should know that first you look out for these symptoms and also the posture of your child, is the rounded shoulders, the visible hump on the back, back pain, stiffness in their legs and hamstrings and then also any danger signs of weakness and numbness and tingling down the legs or loss of sensation. I mean these are signs that you need to get taken care of with at least starting with an x-ray and then if they are really having neurologic symptoms, get MRIs and then refer on to the experts. At St. Louis Children’s Hospital we have an excellent spinal deformity program and we can help further evaluate the child and give you a plan.
Host: And it’s really great information. Do you have any final thoughts on the topic today, Dr. Gupta, on kyphosis itself and what you’d like other providers to know about identifying it and seeking out treatment?
Dr. Gupta: Yes. First of all, I think a basic. Scoliosis is side to side curvature; kyphosis is more of a rounding back. That’s number one. And number two, just because you have kyphosis doesn’t mean it’s the end of the world. People do quite well with it, and it doesn’t develop into severe condition; they have a pretty good life with it. The natural history is quite benign. But if they do develop a significant problem, they can be fixed with a fusion and they have a quite excellent results. And then the congenital is probably the worst one. That is something you don’t want to ignore and prevent neurologic damage and severe deformity from happening. So, those are the things that I would like to stress.
Host: Thank you so much again Dr. Gupta for joining us. It is a pleasure as always to have you as a guest and sharing your expertise. Thank you again.
And that wraps up this episode of radio rounds with St. Louis Children’s Hospital. To consult with a specialist or to learn more about services and resources available at St. Louis Children’s Hospital, please call the Children’s Direct Physician Access Line at 1-800-678-HELP. Or you can head on over to our website at www.stlouischildrens.org for more information and to get connected with one of our providers. If you as a provider found this podcast informative, please share with other providers, share on your social media and be sure not to miss all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.