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Out-of-state? Free MRI review + telehealth consult before you travel4.9 ★ · 619 Google reviewsBoard-certified — American Board of Orthopaedic SurgeryMinimally invasive, same-day spine surgery in Beverly HillsCall (424) 217-7463
Kyphosis is a forward rounding of the upper back. Most cases never need an operation, and the ones that do need careful planning more than anything else.
Every spine has a gentle forward curve in the upper back. Kyphosis is the word doctors use when that curve goes too far, so the upper back rounds forward and the head and shoulders drift ahead of the hips. Some people only notice a change in posture. Others have pain, stiffness, fatigue from holding themselves upright, and, in severe curves, trouble breathing.
There are several types. Postural kyphosis comes from slouching and is flexible. Scheuermann's kyphosis starts in the teen years, when a few vertebrae grow into a wedge shape. In adults, kyphosis often follows osteoporosis and compression fractures, disc degeneration, or earlier spine surgery. A related problem, flatback syndrome, is a loss of the normal inward curve of the lower back. It throws off balance in the same front-to-back plane and is planned for in much the same way.
Dr. Melamed is the former Director of Scoliosis at Cedars-Sinai Marina del Rey Hospital, a role he held from 2013 to 2021 that included complex adult deformity. He looks at kyphosis as a question of whole-spine balance, not only the size of one curve.
✓A visibly rounded upper back or forward head posture
✓Mid-back or upper-back pain and stiffness
✓Fatigue in the back and leg muscles from working to stand upright
✓Leaning forward when standing or walking for longer periods
✓Tight hamstrings or trouble standing fully straight
✓In severe curves, shortness of breath or numbness and weakness from nerve pressure
What causes Kyphosis?
Habitual slouching (postural kyphosis)
Scheuermann's disease, where vertebrae grow into a wedge shape in adolescence
Osteoporosis and vertebral compression fractures
Disc degeneration and arthritis in the aging spine
Earlier spine surgery or fusion that changed the spine's alignment
Less often, congenital malformation, infection, or tumor
How is Kyphosis diagnosed?
Diagnosis starts with a standing exam and full-length standing X-rays of the spine. Those images show the size of the curve, and they also show where your head sits over your pelvis. That balance measurement often matters more than the curve angle itself. An MRI or CT is added when there are nerve symptoms or when surgery is on the table, and a bone-density test is often part of the workup in older adults.
How is Kyphosis treated?
Most kyphosis is managed without surgery. Postural kyphosis responds to posture work and targeted strengthening. A younger patient with Scheuermann's kyphosis may be braced while still growing. When osteoporosis is part of the picture, treating the bone matters as much as the curve.
Surgery is a conversation when a curve keeps progressing, when pain or balance loss limits daily life, or when nerves are compressed. For complex adult deformity, Dr. Melamed plans the correction in detail before the operating room. That often means two stages, so a large correction is split into more manageable steps. He uses custom-made rods matched to the correction he has planned for your spine, and he builds recovery around a non-narcotic pain plan. He will also tell you plainly when surgery is not the right call.
Often, yes. Postural kyphosis usually improves with posture training and strengthening, and a brace can help a growing teenager with Scheuermann's kyphosis. Adults with a fixed, structural curve may still manage well with therapy and pain control. Surgery comes up only when the curve progresses, balance or daily function suffers, or nerves are involved.
When does kyphosis need surgery?
The usual reasons are a curve that keeps getting worse, pain or fatigue that limits daily life despite good conservative care, trouble standing upright, or pressure on the spinal cord or nerves. Dr. Melamed looks at your standing X-rays and your whole-spine balance before recommending anything.
Why would kyphosis surgery be done in two stages?
A large correction in an adult spine is a big undertaking. Splitting it into two planned operations can make each step shorter and gives the body time to recover in between. Dr. Melamed decides on staging case by case, based on the size of the correction and your overall health.
What are custom-made rods?
Rods hold the spine in its corrected position while the fusion heals. Dr. Melamed uses rods made for the individual patient, matched to the alignment he has planned for that spine. Ask him at your consultation how this applies to your curve.
