Non-Surgical Treatment Methods

In the vast majority of mild and moderate kyphosis cases, surgery is not required. Conservative treatment aims to strengthen the muscles supporting the spine, increase flexibility, and stop the progression of the curvature.

1. Physical Therapy and Exercise

Physical therapy is the most important pillar of conservative treatment. The goals are:

• Strengthening of the thoracic extensor and core muscles
• Stretching of the pectoral and hip flexor muscles
• Scapular stabilization exercises
• Spinal re-education based on Pilates and the McKenzie method
• Breathing exercises (to protect lung capacity in severe cases)

2. Brace (Orthosis) Therapy

In growing patients (especially in Scheuermann’s kyphosis), brace therapy is effective in preventing the progression of the curvature. The Milwaukee brace and modified TLSO (thoracolumbar sacral orthosis) are the most commonly used models.

The key point in brace therapy is a usage period of 16–23 hours per day until skeletal maturation is complete. In adults, braces are generally used for pain control, especially for short periods in osteoporotic patients.

3. Pain Management and Medication

The following methods are applied in the management of pain related to kyphosis:

• NSAIDs (non-steroidal anti-inflammatory drugs): Used for short periods during acute pain episodes.
• Muscle relaxants: Can be given as supplementary treatment for paravertebral muscle spasms.
• Osteoporosis treatment: Bisphosphonates and Vitamin D / calcium supplementation reduce the risk of fractures by increasing bone density.
• Epidural steroid injections: Can be applied for radicular pain due to nerve root compression.

4. Manual Therapy and Complementary Approaches

Osteopathy, medical massage, and chiropractic manipulation can accompany physical therapy to reduce muscle tension and improve postural balance. Holistic approaches such as yoga and tai chi increase balance, flexibility, and quality of life, especially in middle-aged and older patients. While these methods cannot correct structural curvature on their own, they are valuable as supportive treatments.

Surgical Treatment: For whom and how?

Surgical treatment comes to the fore in severe kyphosis cases that do not respond to conservative methods, show rapid progression, or present neurological symptoms. In surgical treatment, spinal alignment is corrected using osteotomy (bone incision) techniques, significantly increasing the patient’s quality of life.

Cases Where Surgery Provides Benefit

• Cobb angle exceeding 70°–75° and being resistant to conservative treatment
• Progressive deformity (progression of more than 5° per year)
• Neurological deficit due to spinal cord or nerve root compression
• Serious cardiopulmonary dysfunction (respiratory capacity falling below 50%)
• Uncontrolled pain and functional limitation despite conservative treatment
• Selected cases where cosmetic concerns negatively affect the patient’s quality of life

Osteotomy Techniques

Osteotomy is the process of cutting and removing bone tissue from the vertebra to allow for the realignment of the spine. Different techniques are chosen according to the severity of the deformity and the need for correction:

Smith-Petersen Osteotomy (SPO)

A correction of 10°–15° is achieved at each level by removing the facet joints. It is preferred in mild and moderate flexible curvatures.

Pedicle Subtraction Osteotomy (PSO)

A correction of 25°–35° is obtained by taking a wedge-shaped bone from a single vertebra. It is frequently applied in rigid kyphosis cases; it is a more aggressive but more powerful technique.

Vertebral Column Resection (VCR)

One or several vertebrae are completely removed; a correction of 40°–50° and above is possible. It is applied as a last resort in very severe, rigid deformities and requires high technical skill.

Anterior-Posterior Combined Surgery

Procedures performed from both the front (anterior) and the back (posterior) are applied together in some cases to ensure a more stable correction.

Instrumentation and Fusion

The position corrected after osteotomy is stabilized with pedicle screw-rod systems consisting of titanium screws, rods, and hooks. In addition, bone union (fusion/arthrodesis) is ensured between the vertebrae using autologous bone grafts or synthetic bone substitutes. Fusion guarantees long-term stability.

Minimal Surgical Techniques

With the advancement of technology, robotic navigation systems and minimally invasive techniques make it possible to reduce blood loss and the risk of complications, especially in elderly or comorbid patients. Thoracoscopic anterior release, percutaneous screw placement, and intraoperative neurophysiological monitoring (IONM) have become integral parts of modern kyphosis surgery.

Post-Surgical Recovery Process

A comprehensive rehabilitation process begins after kyphosis surgery. A typical recovery schedule can be summarized as follows:

• First 1–3 days: Intensive care monitoring, breathing exercises, beginning of mobilization (standing up)
• First 6 weeks: Movement restriction, brace use, superficial walking program
• 6 weeks – 3 months: Gradual physical therapy, beginning of muscle strengthening
• 3–6 months: Return to daily living activities, driving, and starting light work
• 6–12 months: Radiological fusion control, gradual transition to sports and heavy physical activity
• 1 year and beyond: Long-term follow-up; usually control X-rays in the 2nd and 5th years