SN4 SHORT NOTE 5M

Define Kyphosis & Gibbus. Describe its causes and management.

General Surgery · Final Professional

Definition

Kyphosis is an excessive posterior (forward-bending) curvature of the spine in the sagittal plane, most often in the thoracic region (a ‘round back’). A localised, sharp, angular kyphosis is called a gibbus. Kyphosis may be postural (flexible, correctable) or structural (fixed).

Causes

Common causes include postural kyphosis (flexible, in adolescents), Scheuermann’s disease (a structural adolescent kyphosis with vertebral wedging), osteoporotic vertebral fractures (the ‘dowager’s hump’ of the elderly), tuberculosis of the spine (an angular gibbus from vertebral collapse), congenital vertebral anomalies, and ankylosing spondylitis.

CLINICAL PEARL

A smooth, round kyphosis suggests a postural, Scheuermann’s or osteoporotic cause, whereas a sharp angular gibbus classically points to vertebral collapse from tuberculosis (Pott’s disease) or a congenital anomaly.

Management

Treatment depends on the cause, magnitude and flexibility.
Postural kyphosis needs only posture training and exercises
Scheuermann’s is managed with physiotherapy and, for larger flexible curves in growing children, bracing. Treat the underlying cause (osteoporosis, tuberculosis with chemotherapy).
Surgical correction and fusion is reserved for severe, progressive or neurologically threatening deformity.

Clinical Note

The distinction between a smooth round kyphosis and a sharp angular gibbus is clinically valuable because it points to very different causes and urgencies: a gibbus in a systemically unwell patient from an endemic area strongly suggests spinal tuberculosis and carries a real risk of cord compression, whereas a gentle round back in an otherwise well adolescent or elderly person suggests a postural, Scheuermann’s or osteoporotic cause managed far less urgently.

CLINICAL PEARL

Let the shape guide you: a sharp angular gibbus means vertebral collapse until proven otherwise — think tuberculosis — whereas a smooth round back points to a postural, Scheuermann’s or osteoporotic cause managed far less urgently.

A sharp angular gibbus strongly suggests tuberculosis of the spine.

KEY POINT

Key points TO remember

Excessive posterior spinal curvature (round back); sharp localised form = gibbus.
Causes: postural, Scheuermann’s, osteoporotic fractures, TB spine (gibbus), AS, congenital.
Smooth round curve vs angular gibbus (TB/congenital) — a key distinction.
Treat the cause; posture/brace for flexible curves; fuse severe/progressive/neurological deformity.

EXAM TIP

Sources: Maheshwari's Essential Orthopaedics; Apley & Solomon's System of Orthopaedics and Trauma; AO Principles of Fracture Management.

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