Kyphosis refers to an excessive forward curvature of the spine that can affect posture, alignment, and overall function. While mild cases may cause minimal symptoms, more significant deformity can lead to pain, fatigue, and difficulty maintaining an upright position.
Aqib Zehri, MD, is a fellowship-trained neurosurgeon in Portland, Oregon, specializing in complex spine and spinal deformity surgery. He evaluates kyphosis in the context of overall spinal alignment and offers individualized treatment options, including non-surgical management and advanced surgical correction when appropriate.
Kyphosis refers to an excessive forward curvature of the thoracic spine (mid to upper back). While a natural degree of curvature is normal, a more pronounced curve can affect spinal alignment, posture, and overall function.
Not all rounding of the upper back represents true structural kyphosis. In some cases, the appearance may be related to posture, while in others it reflects a structural change in the spine that can progress over time.
When kyphosis becomes more significant, it can place increased stress on the vertebrae, discs, and surrounding musculature.
Symptoms vary depending on the severity of the curvature and its impact on overall alignment.
Common symptoms include:
Persistent mid or upper back pain
Fatigue with prolonged standing or sitting
A visible forward rounding of the upper back
Difficulty standing fully upright
Reduced endurance with activity
In more advanced cases, patients may experience:
Progressive deformity
Functional limitation
Breathing difficulty due to restricted chest expansion
Kyphosis can develop from a variety of structural and degenerative processes.
Common causes include:
Degenerative changes – age-related disc and joint wear leading to forward collapse
Compression fractures – often related to osteoporosis, causing vertebral collapse
Postural kyphosis – related to muscle imbalance and prolonged forward positioning
Scheuermann’s disease – a developmental condition leading to structural deformity during growth
Identifying the underlying cause is important in determining the appropriate treatment strategy.
Not all forward rounding of the spine represents structural kyphosis.
Postural changes:
Typically flexible and may improve with effort or positioning
Often related to muscle imbalance or prolonged sitting
Structural kyphosis:
Fixed curvature that does not fully correct with posture changes
Associated with changes in the vertebrae or discs
May progress over time
Distinguishing between these conditions is important, as treatment approaches differ significantly.
Surgical treatment is considered selectively and is typically reserved for patients with structural deformity that is progressive or significantly affecting function.
Surgery may be recommended when there is:
Progressive curvature over time
Significant pain not responsive to conservative treatment
Difficulty maintaining upright posture or horizontal gaze
Functional limitation affecting daily activities
Neurologic symptoms related to spinal cord or nerve compression
In more advanced deformity, surgical correction focuses on restoring spinal alignment and balance. This may involve realignment procedures and stabilization of the spine.
The decision to proceed with surgery is based on:
Severity of the deformity
Overall spinal alignment (including sagittal balance)
Symptom progression
Patient-specific goals and health status
Not all kyphosis requires surgery, and careful patient selection is essential to achieving the best outcomes.
Treatment is individualized based on symptoms, alignment, and the underlying cause.
Non-surgical treatment may include:
Physical therapy focused on posture and core strength
Activity modification
Pain management strategies
Bracing in select cases
Surgical treatment focuses on:
Decompression when there is neural involvement
Realignment of the spine
Stabilization when needed
Dr. Zehri specializes in complex spinal deformity surgery and determines the most appropriate approach based on alignment, deformity characteristics, and patient-specific factors.
Minimally invasive techniques may be utilized in select cases, depending on the surgical goals and underlying pathology.
If you are noticing progressive changes in posture, back pain, or difficulty standing upright, a comprehensive evaluation can help determine whether kyphosis is contributing to your symptoms.
Call the office or request an appointment online to get started.