Kyphosis vs. Lordosis: What Are the Differences?

Updated on 2024-05-16 14:53:24 0 0

Symptoms, Causes, Treatment, and More

By Lana Barhum

Medically reviewed by Theresa Marko, PT, DPT, MS

Kyphosis and lordosis are different curvatures seen in the spine. Excessive kyphosis in the thoracic spine—also called round-back or hunchback—is a spinal deformity where the spine curves forward, resulting in a usual rounding of the upper back.

With excessive lordosis—also called swayback—there is an excessive backward curving of the spine where the abdomen projects out. Both conditions can cause pain and comfort, and can even affect a person’s self-esteem.

Keep reading to learn more about the differences between excessive kyphosis and lordosis. Make sure you see your doctor for an appropriate diagnosis and so you or your child can receive proper treatment.

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Types

Kyphosis and lordosis occur in different subtypes.

Kyphosis Types

Postural kyphosis

Scheuermann’s kyphosis

Congenital kyphosis

Lordosis Types

Postural lordosis

Congenital/traumatic lordosis

Post-surgical laminectomy hyperlordosis

Neuromuscular lordosis

Lordosis secondary to hip flexion contracture

Kyphosis Types

Excessive kyphosis affects up to 10% of school-age children.1 It can also affect adults, especially as they age. There are three types of kyphosis—postural, Scheuermann’s, and congenital.

Postural kyphosis is the most common type. It results from poor posture and slouching. It is more common in teenagers and affects girls more than boys.1 It rarely causes problems other than minor discomfort and a slightly rounded shape in the spine.

Scheuermann’s kyphosis is named after the Danish radiologist who first discovered the condition. With this type of kyphosis, the vertebrae are wedge-shaped rather than rectangular. The wedge-shaped bones will curve forward, make the spine appear rounded.

According to the Cleveland Clinic, Scheuermann’s kyphosis is more common in boys and can be painful, especially with activity or after standing or sitting for long periods.1 Additional symptoms include a hunchback appearance, a stiff spine, and difficulty breathing if the spine curvature is severe.

Congenital kyphosis is present at birth and much rarer than other types. It occurs when the vertebrae develop abnormally in the womb or fuse together.

Congenital kyphosis will get worse as the child grows. Children with this condition may have additional birth defects that affect the heart and kidneys.1 Treatment usually involves surgery in early childhood to stop the curvature from getting worse.

Lordosis Types

There are different types of excessive lordosis—postural, congenital, traumatic, post-surgical laminectomy hyperlordosis, neuromuscular lordosis, and lordosis secondary to hip flexion contracture.

Postural lordosis can be caused by excessive weight and a lack of strong muscle in the back and stomach (the abdominal muscles).2

Congenital lordosis is a birth defect that causes the connecting links of the spine to be misshapen.

Traumatic lordosis is seen in children who have had a sports injury or a fall from a high area, or have been hit by a car.2 These injuries can cause the connecting parts of the spine to break and fracture, and they can cause pain in the lower part of the spine.

Whatever the cause of congenital or traumatic lordosis, the vertebrae, over time, can slip forward and pinch the nerves of the spine, causing pain, numbness, weakness, or dysfunction of the legs.2

Post-surgical laminectomy hyperlordosis can occur in both adults and children, but is more common in children who have had surgery to remove spinal cord tumors.

A laminectomy procedure removes part of the vertebrae to reduce spinal cord or nerve root compression of the spine. If more than one part of the spine is involved, the spine can become unstable and overly curved (hyperlordotic position).2

Neuromuscular lordosis is charged by a variety of neuromuscular conditions, including muscular dystrophy and cerebral palsy.3

Lordosis secondary to hip flexion contracture is often the result of structural changes in the muscles, tendons, and ligaments of the hips, causing the pelvis to rotate forward. This will cause an individual to either lean forward or adopt a hyperlordotic spine to accommodate. The contracture can have various causes, including infection, injury, or muscle problems from different disorders.2

Symptoms

Both excessive kyphosis and lordosis can be painful conditions. They affect different parts of the vertebrae.

Excessive Kyphosis Symptoms

A visible hump of the upper back—appears higher than normal when bending forward

Forward head

Rounded shoulders

Back pain and stiffness

Fatigue

Breathing difficulties

Muscle tightness

Excessive Lordosis Symptoms

Swayback (exaggerated posture—belly forward and swayed back hips)

Gap at the lower back when lying on the back

Pain in the back and legs

Numbness and tingling in the legs

Weakness of the legs

Kyphosis Symptoms

Mild types of kyphosis cause few problems, but severe kyphosis causes pain and can be disfiguring.

Symptoms include:

Downward rounding of shoulders
A humpback
Back pain
Fatigue
Stiffness of the spine
Tight hamstrings

Although rare, severe kyphosis can cause sensation loss in the legs, weakness, numbness, and tingling. Seek out immediate medical attention for these symptoms.

Lordosis Symptoms

Lordosis causes an inward curvature of the lumbar spine, the lower part of the spine just above the buttocks.

The amount of thoracic kyphosis and lumbar lordosis an individual has is based on the relationship between their spine, hips, and pelvis. The angle that determines this is called the pelvic incidence. Since everyone’s pelvic incidence is unique, there are no normal values for lumbar lordosis and thoracic kyphosis.4

Excessive lordosis can cause severe pain in the back and legs for some people.

Additional symptoms might include:

A swayback appearance
A gap between the bed and low back that is noticeable when lying down
Numbness or tingling of the legs
Weakness of the legs

Note that severe leg weakness may require urgent medical attention to avoid serious problems.2

Further, severe complications of excessive lordosis might include loss of movement or restructured movement, fractures, or low back or leg pain.

Body Image

Both kyphosis and lordosis can cause poor body image. This is especially common in children and teens whose backs appear rounded or swayed back, or who need to wear a brace to correct symptoms.

Adults may also have concerns about body image. These concerns can lead to social isolation, anxiety, and depression in both adults and children.

Causes

There are different causes of excessive kyphosis and lordosis.

Excessive Kyphosis Causes

Fractures

Osteoporosis

Disc degeneration

Growth spurts

Birth defects

Childhood syndromes

Cancer or cancer treatments

Risk factors: age, being female, genetics

Excessive Lordosis Causes

Bad posture and slouching

Being overweight

Trauma

Surgery

Neuromuscular conditions

Hip conditions

Kyphosis Causes

The individual bones of the vertebrae would normally appear like stacked cylinders in a column. Kyphosis causes the vertebrae to become wedge-like. This is related to many different causes:

Fractures: A compression fracture in any part of the spine can cause curvature, although mild fractures don’t usually produce any noticeable symptoms.
Osteoporosis: Osteoporosis causes bones to become brittle and weak. It can cause spinal curvature if it affects the spine and causes fractures.
Disc degeneration: The soft, circular discs that act as cushions between the spinal vertebrae can dry out and shrink, leading to spinal curvature.
Growth spurts: Scheuermann’s kyphosis typically starts during the growth spurt before puberty.5
Birth defects: Spinal bones that don’t develop properly before birth can lead to kyphosis.
Childhood syndromes: Childhood kyphosis is sometimes linked to certain syndromes, including Marfan syndrome, a genetic disorder that affects the body’s connective tissue.2
Cancer or cancer treatments: Cancer of the spine can weaken the vertebrae and make a person more prone to spinal compression fractures. Chemotherapy and radiation cancer treatments might also have the same effect.

Risk factors for kyphosis include age and genetics:

Age: After age 40, spine curvature begins to increase. After age 60, 20% to 40% of people have kyphosis. It progresses more rapidly in women.6
Genetics: If you have a family member with kyphosis, you are more likely to have the condition. One 2017 report in the Journal of Bone and Mineral Research found up to 54% of kyphosis occurrences in older adults were linked to genetics.7

Lordosis Causes

Doctors don’t always know the cause of excessive lordosis. What they do know is that the condition often develops in childhood. Some children have a higher risk than others.

Lordosis is also associated with bad posture, being overweight, trauma, surgery, neuromuscular conditions, and hip problems:

Posture: Your lumbar spine relies on the abdominal muscles for support. Children with weak abdominal muscles have a higher risk for lordosis.
Being overweight: Extra belly weight puts strain on the low back and causes it to pull forward, increasing the risk for lordosis.
Trauma: Any trauma to the spine can weaken the spine and cause the vertebrae to curve at an extreme angle.
Surgery: Some types of surgery, including selective dorsal rhizotomy, can lead to lordosis.3 Selective dorsal rhizotomy is a minimally invasive procedure done to reduce leg spasticity (muscle spasms and stiffness) in some people with cerebral palsy.
Hip problems: Children who have hip dysplasia can develop lordosis.3 Hip dysplasia is a condition where the “ball and socket” joint of the hip isn’t properly formed.

Diagnosis

Kyphosis and lordosis are diagnosed using similar methods. Diagnosis might include looking at family and personal medical history, a physical exam of the spine, imaging, and neurologic evaluation.

Family and Medical History

A doctor will ask questions about symptoms experienced, including what causes them and what makes them worse. They will also want to know about a family history of spine curvature disorders, including kyphosis and lordosis.

Physical Exam

A physical exam of the spine looks at spine curvature, balance, and range of motion.

For children, an Adam’s forward bend test is done. This test helps a physician see the slope of the spine and observe spinal deformities or curvatures.8 With this test, your child will be asked to bend forward with their feet together, knees straight, and arms hanging free.

The doctor may also ask the child (or adult) to lie down to see the curvature of the spine. A spine that becomes straightened with lying down is often related to conditions of poor posture.9 But if the spine is still curved with lying down, other causes are considered.

Imaging

X-rays can produce detailed images of the spine to determine curvature, and computed tomography (CT) scans can produce detailed images of sections of the spine.

Magnetic resonance imaging (MRI) scans are done if a doctor suspects another condition, such as a spinal tumor or infection. MRI can produce very detailed images of the bone and tissue surrounding the spine.

Neurologic Evaluation

A neurologic exam is generally done if someone is experiencing tingling, spasms, and/or bladder/bowel control issues. Children and adults who experience these symptoms need to be seen for medical care right away.

Additional Testing

Adults who develop kyphosis or lordosis will need additional testing to determine underlying causes. This might include bloodwork to check for infections and bone density scans to assess the strength of bones and diagnose conditions that cause bone weakening, such as osteoporosis.

Treatment

Treatment for excessive kyphosis or lordosis will depend on the cause and severity of the condition.

Excessive Kyphosis Treatment

Posture improvements

Bracing

Physical therapy

Surgery

Excessive Lordosis Treatment

Pain medicines

Physical therapy

Weight loss

Bracing

Surgery

Managing underlying causes

Kyphosis Treatment

Postural kyphosis can be corrected by improving posture and learning about correct posture for sitting and standing.

Children who have Scheuermann’s kyphosis are often treated with back bracing and physical therapy to strengthen the muscles of the back and abdomen so they can better support the spine. This condition generally stops progressing once the child is older and has stopped growing.10

Children born with congenital kyphosis often require surgery to correct spine curvature. Spinal fusion surgery can correct the curvature and relieve pain.1

Lordosis Treatment

Lordosis treatment is dependent on its cause and severity. Treatment options might include pain medications, physical therapy, weight loss, bracing, and surgery:

Pain medications: Analgesics and anti-inflammatory medications can help manage pain and swelling of the spine and nearby areas.
Physical therapy: Physical therapy can help build strength, improve flexibility, and increase range of motion in the spine and low back.
Weight loss: Losing weight can help reduce stress on weak abdominal muscles.
Bracing: Bracing can control curve progression in children and teens.
Surgery: Surgery to correct lordosis is considered when there is nerve involvement or spinal damage.

When lordosis results from another health condition, such as a hip disorder or a neuromuscular disorder, getting that condition under control can keep the condition from getting worse.

Managing Self-Image Concerns

Being diagnosed with a spine curvature condition can cause a lot of stress for children and teens. When your child is first diagnosed, they feel anxious, depressed, and withdrawn. Fortunately, these symptoms improve as they develop confidence in their treatment plan.

You can help your child develop a positive self-image. Some ways to do this might include:

Discuss with your child their diagnosis and the treatments available.
Assure your child that having a spine curvature condition doesn’t define them as a person and that it won’t affect their ability to be successful.
Accept the feelings your child communicates, and help them to understand those better.
Ask if your child wants help explaining/educating siblings and friends about their condition.
Don’t discourage your child from participating in physical activities unless their physician says otherwise. Exercise can help your child feel better about their body.
Find a support group for your child (or family) so they can get in touch with others facing the same issues. Talking about the challenges of growing up with a spine curvature, playing sports, friendships, and dating can help your child cope better.

Prevention

Kyphosis and lordosis related to posture are preventable by practicing proper posture and being aware of your back health.

Additional prevention measures include:

Avoid slouching, and sit correctly (sit upright, ensuring the back is supported).
Avoid heavy backpacks that put stress on the back muscles and ligaments. According to Harvard Medical School, a backpack should not hang more than a few inches below the waist and should have wide, padded shoulder straps that are firmly tightened.11 Use both straps, and avoid overloading the backpack.
Exercise regularly. Exercises such as swimming, yoga, running, and walking can help to prevent back problems.

Management and treatment of any underlying causes might also help to prevent spinal curvature.

Summary

Kyphosis and lordosis are different spinal curvatures. In excessive kyphosis, the spine curves forward, rounding the upper back. In excessive lordosis, the spine curves backward, resulting in swayback. Both conditions can be painful.

There are a variety of causes for each condition. Diagnosis is through a physical exam, medical history, and imaging. Treatment will depend on the cause and severity.

Sources

Cleveland Clinic. Kyphosis.

Nationwide Children’s. Lordosis.

Boston Children’s Hospital. Lordosis.

MedlinePlus. Lordosis – lumbar.

Bezalel T, Carmeli E, Kalichman L. Scheuermann’s disease: radiographic pathomorphology and association with clinical features. Asian Spine J. 2019;13(1):86-95. doi:10.31616/asj.2018.0025

Roghani T, Zavieh MK, Manshadi FD, King N, Katzman W. Age-related hyperkyphosis: update of its potential causes and clinical impacts-narrative review. Aging Clin Exp Res. 2017;29(4):567-577. doi:10.1007/s40520-016-0617-3

Yau MS, Demissie S, Zhou Y, et al. Heritability of thoracic spine curvature and genetic correlations with other spine traits: the Framingham study. J Bone Miner Res. 2016;31(12):2077-2084. doi:10.1002/jbmr.2925

Studer D. Clinical investigation and imaging. J Child Orthop. 2013;7(1):29-35. doi:10.1007/s11832-012-0461-8

American Academy of Orthopaedic Surgeons. Kyphosis (roundback) of the spine.

Boston Children’s Hospital. Kyphosis in children.

Harvard Medical School. Bad backs and backpacks.

Mirbagheri SS, Rahmani-Rasa A, Farmani F. Evaluating kyphosis and lordosis in students by using a flexible ruler and their relationship with severity and frequency of thoracic and lumbar pain. Asian Spine J. 2015;9(3):416-422. doi:10.4184/asj.2015.9.3.416

Loyola University Medical Center. Scoliosis and spinal curvature disorders.