Orthopedic Surgeons


Kyphosis is a spinal disorder in which an excessive forward curve of the spine results in an abnormal rounding of the upper back. While kyphosis can occur at any age, it is more prevalent in adolescents.

Minor cases of Kyphosis can often be corrected with exercises, physical therapy, and proper posture.

Child in a handstand, she's upside downThe physicians at Medical City Children’s Orthopedic and Spine Specialists have extensive experience treating kyphosis, scoliosis, and other complex spinal conditions. In most cases we can see your child right away, and you don’t have to wait long for an appointment. We also have four convenient locations in Arlington, Dallas, Frisco and McKinney, we are never far away.

Common types of Kyphosis in children and adolescents

In most cases, kyphosis does not cause serious problems requiring surgical treatment. Many patients are able to improve their posture and strengthen their spine through the use of a back brace and/or by doing specific therapeutic exercises. However, severe cases of kyphosis can be painful and cause significant spinal deformity, even leading to breathing problems if left untreated. Patients with this problem may require surgery to reduce their excessive spinal curve and relieve their symptoms.

Types of Kyphosis:

  • Developmental (Postural and Structural/Scheuermann’s) kyphosis – The developmental of this disorder is usually classified as either postural or structural in origin. Both are most commonly seen in children and adolescents, but they may occur at any age.
  • Congenital kyphosis – The disorder an curvature of the spine is present at birth and occurs when the spinal column fails to develop normally before the child is born.
  • Post-Traumatic kyphosis – Usually resulting from an accident or injury, post-traumatic kyphosis is commonly seen in the mid- to lower-back.
Postural Kyphosis
Postural kyphosis is the most common type of this disorder and usually becomes evident in childhood. Postural kyphosis occurs more frequently in girls than in boys, rarely causes pain, and doesn’t normally lead to problems in adulthood because the curve is usually not progressive.

Structural/Scheuermann’s Kyphosis

Physician examining a little girls spineStructural kyphosis (also called Scheuermann’s kyphosis) occurs when the structure of the spine develops abnormally, most often with the front sections of the vertebrae growing slower than the back. Instead of normal, rectangular vertebrae with ideal alignment, structural kyphosis results in more triangular, wedge-shaped vertebrae that cause misalignment.

Structural kyphosis usually develops during periods of rapid bone growth, typically between the ages of 12 and 15 in males or a few years earlier in females. The curve caused by this abnormality is usually sharp and angular, as well as stiff and rigid. Unlike the postural type, structural kyphosis cannot be corrected simply by standing up straight.

Congenital Kyphosis

While congenital kyphosis is not common, it can be quite debilitating. It may involve the bones developing in an unusual shape (called failure of formation), or when several vertebrae become fused together (called failure of segmentation).

Unfortunately, casting and/or bracing has not been shown to be effective treatments for patients with congenital kyphosis. This type of abnormality usually requires surgical treatment at a very young age to stop the progression of the curve.

Post-Traumatic Kyphosis
Post-traumatic kyphosis usually arises as the result of an injury such as a fall from a height, a motor vehicle accident, or a horseback riding accident. The impact from these kinds of injuries can lead to fractures and/or dislocation of the vertebrae, which can lead to a kyphotic curve of the spine, especially if the injury is not treated promptly.

Symptoms of Kyphosis

The most common symptom of kyphosis is a rounding of the upper back, which can force the head forward and lead to pain in the back and neck. Other symptoms may include a difference in shoulder height and shoulder blade height, as well as tightness in the hamstring muscles in the back of the thighs.

Diagnosing Kyphosis in Children

During an exam, Dr. Kishan, Dr. Hostin, or Dr. Wiesman will ask your child to bend forward with both feet together, knees straight, and arms hanging free. This test, known as Adam’s forward bend test, allows the doctor to better observe the curve of the spine and spot any spinal deformity.

The doctor may also ask your child to lay down to see if this straightens the curve, which is a sign that the curve is flexible and may be a result of postural kyphosis. They may also order X-rays to determine if there are changes in the vertebrae or any other bony abnormalities.

In patients with postural kyphosis who do not have any abnormalities in the shape of the vertebrae, the forward curve is typically flexible and can be corrected simply by encouraging proper posture.

Kyphosis is becoming more common in kids and adolescents

“Postural Kyphosis is a benign condition, but one that needs to be addressed before the curve can progress. This is caused by poor posture that causes the child to sit slumped forward. A lot of children today who are into playing video games or electronics often sit this way. Thankfully, this is something that can be corrected with exercises and by correcting the posture of the child.” Shyam Kishan, MD

Nonoperative Management

Observation and physical therapy are typically recommended for:

  • Postural kyphosis (the back can be straightened with proper posture)
  • Curves that are less than 60° in patients who are growing
  • Curves 60° – 80° in patients who are finished growing

X-Rays and Exercise

Full-spine X-rays are usually taken every 6 months as the child grows using our advanced imaging system that scans the entire spine in just seconds while delivering an extremely low dose of radiation.


With a moderately severe curve (60° – 80°) and a patient who is still growing, brace treatment in conjunction with a tailored exercise program may be recommended. Full-time use of a brace (20 hours/day) is usually required in the beginning until maximum correction has been achieved.

In the final year of treatment prior to skeletal maturity, your child’s physician may propose part-time bracing (12-14 hours/day). Your child must continue to wear the brace for a minimum of 18 months in order to significantly and permanently correct their kyphosis.

Operative Treatment

At Medical City Children’s Orthopedics and Spine Specialists, we consider surgery only when it is absolutely necessary. Our pediatric orthopedic surgeons use the most advanced treatment options to ensure that patients can return to normal daily activities as soon as possible.

Spinal Fusion

If kyphosis has become severe (greater than 80°) and causes frequent back pain, surgical treatment may be recommended. Surgery can significantly correct the deformity without the need for postoperative bracing. Instrumentation (screws, hooks, and/or sublaminar cables) is then used to keep the spine stable and ensure that it heals properly.

Thanks to Medical City Children’s Orthopedics and Spine Specialists’ enhanced recovery after spine, pelvic and hip procedures, hospital stays for spinal fusions performed here are shorter than most.

While most surgeries are performed from the back, your child’s pediatric orthopedic surgeon may recommend additional surgery on the front of the spine. Patients are usually able to return to normal daily activities within 4 to 6 months following surgery.

Spine Osteotomy

Spine osteotomy is a surgical procedure in which a section of the spinal bone is cut and removed to allow for correction of the spinal alignment. The Smith-Peterson Osteotomy is one of the most common procedures and involves removing sections of bone from the back of the spine, as well as the posterior ligament and facet joints. This causes the spine to lean more toward the back, correcting the kyphotic curve.

Long-Term Prognosis

Should your child require surgery to correct kyphosis, the expert surgeons and caregivers at Medical City Children’s Orthopedics and Spine Specialists can provide the care and attention they deserve. In addition, Dr. Richard Hostin, Dr. Kathryn Wiesman, and Dr. Shyam Kishan have been treating children and adolescents for more than 10 years.

When kyphosis is diagnosed early, the majority of children can be treated successfully without surgery and go on to lead active, healthy lives. If the problem  is left untreated, however, progression of the curve could potentially lead to problems in adulthood.

At Medical City Children’s Orthopedic and Spine Specialists, our physicians have successfully performed 5,900 surgeries, so you can rest assured your child is in good hands. In the case that your child requires surgery, our compassionate medical team will sit down and discuss with you all the options available so your family can make an informed decision.

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at three convenient locations: Arlington, Dallas, Frisco and McKinney.