Hunchback or Dowager's Hump

Kyphosis is also known as Dowager's Hump, hunchback, or humpback. This condition is the result of a curvature of the cervical and thoracic spine at an angle greater than in a healthy individual. In a normal curvature, the spinal column begins an S shaped curve beginning at the base of the skull, and ending at about the middle of the thoracic spine, where it begins to curve in the other direction. This curvature is normal, and it gives us the ability to sit, stand, and walk upright. The normal angle of curvature along the spine is as follows.
  • Cervical : 20 to 40 degrees
  • Thoracic: 20 to 40 degrees
  • Lumbar: 40 to 60 degrees
  • Sacral: Sacrum fused in a Kyphotic curve.
Any angle of curvature greater than 40 degrees in the cervical curve results in cervical lordosis, and any angle of curvature greater than 40 degrees in the thoracic curve results in Thoracic Kyphosis. The cause of the condition of hunchback or Dowager's Hump may be the result of bone disease (such as osteoporosis), degenerative diseases (such as osteoarthritis), accident/trauma, compression fractures of the vertebrae, and developmental problems such as Scheuermann's disease (uneven growth of the vertebrae). Severe cases of Dowager's Hump may be apparent to the average person, has an obvious stooped and slouched over posture when sitting or standing. Beyond the obvious physical disfigurement of the hump, the person may experience reduced mobility and physical comfort, and may even experience labored breathing. Severe cases of this condition may cause the person to have physical disability and inability to walk or worse. This condition is more likely to affect older people, with women affected more often due to their increased risk of development of osteoporosis after menopause. In adults, the most common cause of cervical kyphosis is osteoporosis. In children and adolescents, the condition is rare, but it can be caused or inherited by injury or infection.

Cause: Scheuermann's disease and Marfan syndrome are two of the most common causes of Kyphosis (Hunchback) in children.

Scheuermann's disease is caused by abnormal development of the vertebrae during the growth of children and adolescents. With this disease, the vertebrae grow unevenly, resulting in the anterior angle being greater than the posterior. This condition is more serious and difficult to treat. Patients with this condition will have a more difficult making improvements in their spine through physical therapy as those with postural kyphosis would. Treatment options for this conditions will include back braces to help stop or reverse the condition, specialized physical therapy, and spinal fusion with specialized instrumentation ( e.g. pedicle screws, rods).

Marfan syndrome is a genetic disorder of the connective tissue. Marfan syndrome is an uncommonly hereditary connective tissue disorder that results in abnormalities of the blood vessels, heart, bones, and eyes. Many of the connective tissues of the body are elongated, including the joints. Flatfeet and a humpback with an abnormal curve are common, as are hernias. Unless the patient with marfan syndrome has a severe Dowager's Hump related to this condition, it won't be considered serious. If the pain does experience back pain or discomfort, treatment options include ultrasound and skeletal adjustment, TENS therapy, and possibly hormone therapy during adolescence to slow the rate of growth.