Kyphosis is an exaggerated curvature (over 400) of the upper and mid-thoracic spine that can be present at birth, develop during adolescence or in adult life (Box 1).
Postural kyphosis (‘roundback’) is due to poor postural habits, such as slouching, and carrying heavy backpacks or schoolbags. These activities stretch the ligaments and, in some cases, the muscles supporting the vertebrae. This can pull the thoracic vertebrae from their normal position, resulting in curvature. This may require patients to sleep with additional pillows. When patients with postural kyphosis lie down, the spine straightens, but in kyphosis it remains fixed.
Kyphosis reduces the vital capacity of the lungs, affecting respiration. If nerves are compressed by mechanical problems, pain and neurological symptoms can result, including 'pins and needles' or loss of dexterity in the hands. If the spinal cord is severely damaged, tetraparesis (partial loss of function or quadraparesis) or tetraplegia (complete loss of function or quadraplegia) can result.