Adult Kyphosis (Hunchback)
The sagittal alignment of the spine continuously changes from birth to old age. At birth, the entire spine from the neck to the tailbone curves forward. As a child begins to stand upright, the lumbar region first develops a forward C-shaped curve, followed by a reverse C-shape in the thoracic spine. Eventually, four alternating curves develop sequentially in the neck, thoracic spine, lumbar spine, and pelvis.

What Is Adult Kyphosis?
Also known as hunchback, adult kyphosis is an excessive forward curvature of the thoracic spine. The angulation occurring in the vertebrae of the upper back exceeds the normal range.
In lateral radiographs taken in a relaxed position, the Cobb angle measured between the superior endplate of T5 (fifth thoracic vertebra) and the inferior endplate of T12 (twelfth thoracic vertebra) normally ranges from 10 to 40 degrees. An angle greater than 40 degrees is considered kyphosis, meaning the curvature in the back is more pronounced than normal.
Although kyphosis can result from various causes, the best-known form is structural and typically appears during adolescence (ages 12–15), known as Scheuermann’s kyphosis. Its exact cause remains unknown.

Insufficient exercise and poor posture habits can predispose individuals to kyphosis. While some people stand more upright, others tend to appear more hunched. The most common reason for this is postural kyphosis, also called pseudo-kyphosis.

The wide range of what is considered physiologically normal (10–40 degrees) and individual or postural differences can lead to misinterpretation. For instance, a person with a 35-degree kyphosis may appear to have a 55-degree curvature due to poor posture. This is referred to as postural kyphosis. This is typically the type of hunchback observed by parents in their children. In such cases, although a protrusion is seen when the person is standing, it disappears when lying down, and there is no structural deformity of the spine. This condition may also be referred to as hyperkyphosis within physiological limits.

What Causes Kyphosis?
While kyphosis can be genetic, known causes include:

• Degeneration of the spine due to external factors
• Degenerative disc disease resulting from osteoporosis
• Fractures due to trauma or accidents
• Congenital spinal abnormalities (e.g., myelomeningocele)
• Inflammation and infection in tissues around the spine
• Primary infections of the spine such as tuberculosis (TBC)
• Neuromuscular disorders
• Tumors affecting the spine

What Are the Symptoms of Adult Kyphosis?
The most apparent symptom is forward curvature. Apart from round shoulders and a hunched appearance, kyphosis typically doesn’t cause significant pain. Common symptoms include:

• Stiffness and pain in the upper back and shoulders
• Persistent numbness and weakness in the legs
• Extreme muscle fatigue
• Postural disorders and difficulty standing upright
• Shortness of breath and difficulty breathing
• Increased spinal sensitivity

How Is Adult Kyphosis Diagnosed?
A simple test parents can do provides some insight into the condition’s severity. If telling a child to stand up straight significantly corrects the curve, the issue is likely postural. However, it’s crucial to note which part of the spine straightens. If the most protruding part corrects, there may be no structural problem. Otherwise, professional evaluation is necessary.
When viewed from the side, individuals with kyphosis often appear to have their head positioned in front of the body.

The diagnosis of adult kyphosis is usually straightforward based on symptoms and physical appearance. Radiological imaging is used to measure the kyphotic angle. In advanced cases, pulmonary function tests should also be performed. If the patient experiences symptoms due to spinal pressure (e.g., urinary or fecal incontinence), more detailed tests such as MRI should be conducted.

Can Kyphosis Be Prevented?
Poor posture is the most common cause of kyphosis. Therefore, if no underlying condition is present, certain exercises—often called kyphosis exercises—can help. Strengthening the abdominal, chest, leg, and spinal muscles can reduce kyphosis to within normal limits.

Can Adult Kyphosis Be Treated?
Almost everyone has a slight natural curvature of the spine, known as hyperkyphosis. What matters is the measured degree of the curvature. In cases with a curvature up to 50–55 degrees, regular exercise and proper posture techniques can lead to significant improvements. For curvatures between 50–70 degrees, a kyphosis brace is recommended in addition to exercises. In more severe cases, surgical consultation is required.

Less severe kyphosis is usually due to weakened back muscles. These individuals should perform kyphosis exercises, particularly physical therapy routines that include reverse crunches, under professional supervision. The use of a kyphosis brace should be prescribed and monitored by a doctor and is typically recommended only during standing and working hours.