Orthopedic Surgery

Kyphosis

Kyphosis is a forward curvature of the spine in the upper back — best seen from the side, in contrast to scoliosis — giving a child an abnormally rounded or “humpback” appearance. It is a type of inflexible spinal deformity and should not be confused with poor posture or "round back," which is flexible.

Kyphosis and lordosis (an inward curvature of a portion of the lower spine) can be associated with early-onset scoliosis, a form of thoracic insufficiency syndrome. In thoracic insufficiency syndrome, a child's lungs do not get enough air because the spinal curves affect rib and lung growth and development.

Kyphosis can be congenital (present at birth) or caused by trauma, infection or underlying conditions such as:

Symptoms

Common symptoms of kyphosis include:

Evaluation and diagnosis

The normal spine naturally has curves of 20 to 50 degrees in the neck (cervical region of the spine), chest (thoracic region) and lower back (lumbar region). When the curves become more pronounced and the curve becomes abnormally convex (bowed out), the patient is described as having kyphosis.

Early detection of kyphosis is important to obtain the best outcome for your child. To determine if your child has kyphosis, an orthopedic physician will conduct a family and medical history, perform a physical examination and visual inspection of your child's back, and review any relevant radiological studies.

A diagnosis of kyphosis is made by detecting a severe curvature of the upper portion of your child's spine on an X-ray. If possible, we try to use adequate imaging without excessive radiation exposure.

Other diagnostic tests may include:

Holistic, individualized treatment

At The Children’s Hospital of Philadelphia, we practice family-centered care in a collaborative environment. Our multidisciplinary team of experts includes world-renowned orthopedic surgeons and physicians, specially trained pediatric nurses, physical and occupational therapists, psychologists and other specialists. Together, we partner with you to provide the best care for your child.

We offer both surgical and nonsurgical treatments for kyphosis. The optimal treatment for your child will be determined based on the degree of curvature, the age and growth stage of your child, and whether the curve is getting progressively worse.

For children who are still growing and have less severe spinal curvatures, a back brace may be prescribed as a nonsurgical treatment. The brace can help control your child's spine curvature. Physical therapy and anti-inflammatory medication may be prescribed in conjunction with the brace to extend your child's range of motion, as well as ease any pain or discomfort.

Surgery 

Surgery may be recommended when back bracing is not successful in slowing down the progression of the curve and rigid or progressive kyphosis greater than 80 degrees is detected.

Surgery can dramatically improve kyphosis, but can also be a stressful experience for both child and parent. At CHOP, we offer a wealth of resources about how to prepare your child for surgery, what to expect during surgery and specific ways we make safety in surgery a top priority.

The most common surgical treatments for kyphosis include:

Determining which surgery is right for your child will depend on your child's age and skeletal maturity, along with other medical considerations. 

Growing rods and VEPTR

If your child is still growing, either implanting growing rods or implanting VEPTR will likely be the recommended treatment. Both devices — once surgically implanted — can be adjusted in minor surgery as your child grows.

Growing rods are the more traditional treatment in which one or two metal rods are inserted into the child's back. The rods are placed under the skin to avoid damaging the growth tissue of the spine and are attached to the spine at two spots — above and below the curve.

VEPTR is a newer treatment that was invented and pioneered by one of CHOP’s own pediatric orthopedic surgeons. The VEPTR was created specifically as a lifesaving treatment for thoracic insufficiency syndrome, in which a child's spinal curve is severely affecting lung growth. If left untreated, thoracic insufficiency syndrome can be fatal.

If your child has kyphosis and early-onset scoliosis, clinicians will likely recommend VEPTR implantation.

In VEPTR surgery, the expandable titanium ribs are implanted into a child's back and chest, and anchored to the spine and ribs. The VEPTR helps to correct and stabilize the curved spine, allowing the child's ribs, lungs and spine to grow and develop more fully.

Whichever device is implanted will need to be expanded or lengthened every six months as your child grows and reaches skeletal maturity (about 14 years old for girls and 16 years old for boys).

Spinal fusion  

Deformity correction and spinal fusion surgery may be recommended in older children when growing rods are not a consideration (usually after age 10) or after to permanently correct and stabilize the spine.

In spinal fusion surgery, the abnormal curved spinal bones may be realigned with metal rod implants inserted to correct the curvature, and the spinal correction made permanent with spinal fusion.

Follow-up care

After treatment — whether surgical or nonsurgical — the clinical team at The Children's Hospital of Philadelphia will continue to follow-up on your child's care at our Main Campus or in one of our CHOP Care Network locations. Our team will meet with you regularly to review your child's progress and revise treatment goals as needed.

If back bracing was required, your child will be re-evaluated every six months until the spine is stable. After that point, annual visits to an orthopedic doctor are recommended.

If your child received growing rods or VEPTR, an additional surgery — spinal fusion — may be necessary when your child has finished growing. Annual visits to an orthopedic doctor are recommended after spinal fusion.

At CHOP, we offer ongoing support and services for patients and their families. Our team is committed to partnering with parents and other caregivers to provide the most current, comprehensive and specialized care possible for your child.

We also recognize your child's pediatrician is an important part of the care team and will provide regular updates on your child's progress. If continued care is necessary as your child becomes an adult, we will help transition your child's care to an adult orthopedic team.

Long-term outcomes

With successful treatment and careful postoperative care, children with corrected kyphosis have excellent outcomes and can lead active, healthy lives.

Resources

To learn more about kyphosis and treatment options, visit:

Contact us

To make an appointment with the Division of Orthopedic Surgery at The Children's Hospital of Philadelphia, call 215-590-1527 or contact us online.

Reviewed by: Denis S. Drummond, MD
Date: January 2013

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