KYPHOSIS

(CURVED THORACIC SPINE)

What is Kyphosis ?

Kyphosis (plural: kyphoses), much

less commonly kyphus, is a term
used to describe the sagittal
curvature of the thoracic spine.
Everyone has some degree of
curvature in their spine.
However, a curve of more than 45
degrees is considered excessive.
• The normal range of the Cobb angle for
thoracic kyphosis is typically considered to
be between 20 and 40 degrees.

• An angle greater than 40 degrees is

generally considered an abnormal increase in
thoracic kyphosis, which may be indicative
of a spinal disorder such as Scheuermann's
disease, osteoporosis, or ankylosing
spondylitis.

• In some cases, a Cobb angle less than 20

degrees may also be considered abnormal,
particularly if it is accompanied by
symptoms such as back pain or spinal
stiffness.
• To measure the Cobb angle, one
must first decide which vertebrae
are the end vertebrae of the
curve deformity (the terminal
vertebrae) – the vertebra whose
endplates are most tilted towards
each other.

• Lines are then drawn along the

endplates (or the pedicles if the
endplates are not properly
visualized ), and the angle
between the two lines, where they
intersect, measured. 

• In cases where the curvature is

not marked, then the lines will
not intersect on the
film/monitor, in which case a
further two lines can be plotted,
each at right angles to the
Etiology
An increased Cobb angle is seen in the following conditions:
• Scheuermann’s disease
• Congenital Kyphosis
• Osteoporosis
• Spondyloarthropathies
• Vertebral body Fractures
• Compression fracture
• Pathological fracture
A decreased Cobb angle is seen in the following condition:
• Straight back syndrome
Scheuermann disease

• Scheuermann kyphosis, also known as Scheuermann disease, juvenile kyphosis,

or juvenile discogenic disease, is a condition of hyper-kyphosis that
involves the vertebral bodies and discs of the spine identified by anterior
wedging of greater than or equal to 5 degrees in 3 or more adjacent
vertebral bodies. The thoracic spine is most commonly involved, although
involvement can include the thoracolumbar/lumbar region as well
• Occurs in the thoracic spine in up to 75% of cases, followed by the
thoracolumbar spine combined and occasionally lumbar and rarely cervical
spine. 
• type I: thoracic spine only
• type II: affecting the lower thoracic spine and lumbar spine
Radiographic features
To apply the label of classical Scheuermann disease, the Sorensen
criteria need to be met :
•thoracic spine kyphosis >40° (normal 25-40°) or
•thoracolumbar spine kyphosis >30° (normal ~0°)
and
•at least 3 adjacent vertebrae demonstrating wedging of >5°
Other signs include:
•vertebral endplate irregularity due to extensive disc invagination
•intervertebral disc space narrowing, more pronounced anteriorly
The condition is associated with
•Schmorl nodes
•limbus vertebrae
•scoliosis (~25%)
•spondylolisthesis
 MRI

The Sagittal T2-

The Cobb angle
weighted image of
is measured as
the thoracic
46 degrees;
spine
intersecting
demonstrates an
vectors are
exaggerated
drawn from the
kyphosis with
superior
mild anterior
endplate of T2
wedging of the T5
to the
through T10
inferior
vertebral bodies.
endplate of
Signal loss is
T10,
present in
representing
multiple
the boundaries
intervertebral
of the
discs with
kyphotic
associated
curve.
endplate
irregularity and
Schmorl’s nodes.
A Sagittal T2-weighted image of the lower
thoracic and lumbar spine shows anterior
wedging of the T11, T12, and L1 vertebral
bodies, with associated endplate
irregularity from T11 to L2. Mild
posterior wedging of the L2 vertebral body
is also noted.
This is a 2nd type of SD, affecting the
thoracolumbar junction or the lumbar
spine, referred to as “lumbar
Scheuermann’s”
Lateral X-ray - Zoomed image

Mild ventral wedging of T8, T9 and

T10 vertebrae showing endplate
irregularity (thoracic spine
kyphosis measures 55.4) degrees.
CT

There is mild, chronic wedging of lower thoracic vertebral bodies, with Schmorl's nodes and disc
space narrowing. No acute compression fracture. Facet joints are enlocated. Posterior elements are
intact. 
 Congenital Kyphosis
• It is the least common type of abnormal kyphosis.
• It is caused by abnormal development of the
vertebrae prior to birth
• Occurs due to fusion of many vertebrae together.

Failure of Formation deformity. Failure of Separation

deformity
X-RAY

Thoracolumbar spine kyphosisangle about

65°.
Dorsal hemivertebra deformity involving
T12.
 MR
I

Block vertebrae involving T12/L1 and

L2/3.
Lumbar scoliosis with convexity
towards left side.
 X-RAY

Lateral chest radiography showing grade 2

osteoporotic vertebral fracture at T11
with 35% height loss measured by dividing
the height of the posterior border of
the vertebral body by the anterior height
(white lines).
 CT

Thoracic spine compression

fractures

There are multiple healing

bilateral rib fractures and
comminuted sternal body
fractures. There are also mild T4
and T5 wedge compression
fractures and a severe wedge
compression fracture of T10
associated with gas and mild
spinal canal compression (less
than 20%).  
Straight back syndrome
Straight back syndrome refers to decreased thoracic kyphosis ("flattening") and decreased
anteroposterior thoracic diameter, such that there is compression of cardiovascular or bronchial
structures. It should not be confused with flat back syndrome, which refers to decreased lumbar
lordosis, often in the setting of spinal fusion and without intrathoracic compression .

Clinical presentation
Most patients are asymptomatic. On precordial auscultation, individuals with this condition can
have an ejection systolic murmur over the pulmonary area due to compression of the right
ventricular outflow tract (RVOT) . Uncommonly, patients may complain of chest pain, palpitations
and lightheadedness.
More rarely, patients may present with dyspnea, resulting from compression of the trachea or
bronchi .

Radiographic features
•loss of the normal kyphosis of the upper thoracic spine.
•the distance from the middle of the anterior border of the T8 vertebra to a vertical line
connecting the anterior borders of T4 and T12 is <1.2 cm.
•the anteroposterior diameter on the lateral chest x-ray from anterior border of the T8 vertebra
to the posterior border of the sternum is <10-11 cm.
•the cardiothoracic ratio is usually less than 0.5
•the heart may be shifted leftwards with a prominence the main pulmonary artery.
CT

No relevant pulmonary abnormalities. The

patient presents a rectification of the
physiologic thoracic kyphosis, with a
straight alignment of vertebral bodies and
a chronic anterior displacement of all
thoracic spine, compressing mediastinal
structures anteriorly. Also noted screws
related to a previous spine surgery
 Treatment of Kyphosis
Braces: A brace is normally suggested for teenagers, who are still growing and
are suffering from moderate to serious kyphosis. The brace slows down or
prevents further progression of the condition.

Medications: Pain is one of the common symptoms of kyphosis. The doctor may
prescribe - acetaminophen and NSAIDs (non-steroidal anti-inflammatory drugs).
Exercises: exercises that are designed to relieve symptoms of kyphosis.
eg : posture improving exercises 

Surgery: Surgery is considered to be an option for treatment when the

condition is congenital, caused by a cancerous growth, causes sharp pain,
and involves some neurological or extreme deformities, which cannot be
cured with non-surgical methods like, bracing and physiotherapy
References
• https://www.nhs.uk/conditions/kyphosis/
• https://radiopaedia.org/articles/kyphosis
• https://radsource.us/scheuermannsdisease
• https://www.sciencedirect.com/science/article/pii/
S0846537115000145
THANK YOU
Raigan Benny
Group 2
Semester 12