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The present study aims to qualitatively review the contributing factors and health implications of age-related hyperkyphosis. We conducted a narrative review of observational and cohort studies describing the risk factors and epidemiology of hyperkyphosis from 1955 to 2016 using the following key words: kyphosis, hyperkyphosis, posture, age-related hyperkyphosis, kyphotic posture, aetiology and causes. This review included 77 studies. Approximately 60–70 % of the most severe hyperkyphosis cases have no evidence of underlying vertebral compression fractures. Other proposed factors contributing to hyperkyphosis are degenerative disc disease, weakness of back extensor muscles and genetic predisposition. Strength and endurance of back extensor muscles are very important for maintaining normal postural alignment. Recent evidence suggests that age-related hyperkyphosis is not equivalent to spinal osteoporosis. Due to the negative impact of hyperkyphosis on physical function, quality of life and mortality rates, physicians should focus not only on osteoporosis, but also on age-related postural changes. More research about the relationship between spinal morphology and modifiable factors, especially the structural and functional parameters of trunk muscles, could further illuminate our understanding and treatment options for hyperkyphosis.

Summary Designing appropriate diagnostic and treatment methods to reduce fall risk and improve quality of life, as well as reduce the cost of care in elderlies. Our findings have potential for early diagnosis of those with a high probability of falling based on fairly simple clinical measures of hyperkyphosis, forward head, and lordosis. Introduction Poor balance is an underlying cause of falling in the elderly, for which a change in the natural curvature of the spine plays a major role. Little is known about the relationship between spinal curvatures and fall incidence in this population. We primarily aimed to investigate the relationship between sagittal plane spinal curvatures and fall incidence over 1 year among nursing facility residents. Secondarily, we aim to determine associations of sagittal plane spinal curvatures with participants’ perception of fall risk and balance capability. Methods Participants (100 residents mean age 70.17 ± 6.01 years) underwent standing measures of sagittal plane spinal curvatures (flexible ruler technique) and forward displacement of the head relative to the cervical spine. The Tinetti Performance Oriented Mobility Assessment (POMA) and Fall Efficacy Scale assessed participants’ perception of balance and fear of falling. Incident falls were self-reported monthly and tracked across 1 year. Spearman’s correlations and logistic regression evaluated associations between fall incidence and spinal curvature. Predictive performance of spinal curvature and fall risk was determined by the corresponding ROC for defining a cut-off for variables of spinal curvature and fall risk indicators. Results Predictive performance of spinal curvature and fall risk factors indicated 84% and 77% of participants were correctly classified using models of kyphosis and head angle, respectively. Conclusions Our study adds new data on spinal curvatures and incident falls among nursing facility residents. Efforts are needed to intervene to counter progression of spinal curvatures and improve fall prevention practices.

The main objective of this study was to analyze the effect of a resistance training program using outdoor fitness equipment (OFE) on sagittal spine disposition and pelvic tilt in middle-aged and older adults. One hundred and twenty-eight middle-aged and older adults were randomly assigned to the training (TG) or control group (CG). The TG trained for 8 weeks, with 2 weekly sessions of one hour of resistance circuit training with OFE. Before and after the intervention, the sagittal spine disposition and pelvic tilt in the relaxed standing and sitting positions were analyzed. The results showed that the TG obtained a significant reduction (p < 0.001) in all the curvatures of the sagittal spine disposition and pelvic tilt in the standing position after the intervention, in contrast to the CG, which only showed a significant reduction in pelvic tilt (p = 0.005). Regarding the sitting position, only the TG presented a significant decrease in lumbar lordosis (p < 0.001). In conclusion, resistance training with OFE may be useful in improving sagittal spine disposition in middle-aged and older adults. Given the availability of free OFE in parks, the present research provides elders with an accessible and effective training program to curb the effects of ageing on the sagittal spine disposition.

Background Thoracic kyphosis is reported to increase with ageing. However, this relationship has not been systematically investigated. Peoples’ kyphosis often exceeds 40°, but 40° is the widely accepted cut-off and threshold for normality. Consequently, patients may be misclassified. Accurate restoration of kyphosis is important to avoid complications following spinal surgery. Therefore, specific reference values are needed. The objective of the review is to explore the relationship between thoracic kyphosis and age, provide normative values of kyphosis for different age groups and investigate the influence of gender and ethnicity. Methods Two reviewers independently conducted a literature search, including seven databases and the Spine Journal, from inception to April 2020. Quantitative observational studies on healthy adults (18 years of age or older) with no known pathologies, and measuring kyphosis with Cobb’s method, a flexicurve, or a kyphometer, were included. Study selection, data extraction, and study quality assessment (AQUA tool) were performed independently by two reviewers. The authors were contacted if clarifications were necessary. Correlation analysis and inferential statistics were performed (Microsoft Excel). The results are presented narratively. A modified GRADE was used for evidence quality assessment. Results Thirty-four studies (24 moderate-quality, 10 high-quality) were included (n = 7633). A positive moderate correlation between kyphosis and age was found (Spearman 0.52, p < 0.05, T5-T12). Peoples’ kyphosis resulted greater than 40° in 65% of the cases, and it was significantly smaller in individuals younger than 40 years old (x < 40) than in those older than 60 years old (x > 60) 75% of the time (p < 0.05). No differences between genders were found, although a greater kyphosis angle was observed in North Americans and Europeans. Conclusion Kyphosis increases with ageing, varying significantly between x < 40 and x > 60. Furthermore, kyphosis appears to be influenced by ethnicity, but not gender. Peoples’ thoracic sagittal curvature frequently exceeds 40°. Trial registration The review protocol was devised following the PRISMA-P Guidelines, and it was registered on PROSPERO ( CRD42020175058 ) before study commencement.

Purpose To evaluate the neuronal metrics/microstructure of the spinal cord around apical region in patients with hyperkyphosis using diffusion tensor imaging (DTI). Methods Thirty-seven patients with hyperkyphosis aged 45.5 ± 19.6 years old who underwent 3.0 T magnetic resonance imaging (MRI) examination with DTI sequence were prospectively enrolled from July 2022 to July 2023. Patients were divided into three groups according to spinal cord/ cerebrospinal fluid (CSF) architecture on sagittal-T2 MRI of the thoracic apex (the axial spinal cord classification): Group A—circular cord with visible CSF, Group B—circular cord without visible CSF at apical dorsal, and Group C—spinal cord deformed without intervening CSF. The fractional anisotropy (FA) values acquired from DTI were compared among different groups. Correlations between DTI parameters and global kyphosis (GK)/sagittal deformity angular ratio (sagittal DAR) were evaluated using Pearson correlation coefficients. Results In all patients, FA values were significantly lower at apical level as compared with those at one level above or below the apex (0.548 ± 0.070 vs. 0.627 ± 0.056 versus 0.624 ± 0.039, P  < 0.001). At the apical level, FA values were significantly lower in Group C than those in Group B (0.501 ± 0.052 vs. 0.598 ± 0.061, P  < 0.001) and Group A (0.501 ± 0.052 vs. 0.597 ± 0.019, P  < 0.001). Moreover, FA values were significantly lower in symptomatic group than those in non-symptomatic group (0.498 ± 0.049 v. 0.578 ± 0.065, P  < 0.001). Pearson correlation analysis showed that GK ( r 2  = 0.3945, P  < 0.001) and sagittal DAR ( r 2  = 0.3079, P  < 0.001) were significantly correlation with FA values at apical level. Conclusion In patients with hyperkyphosis, the FA of spinal cord at apical level was associated with the neuronal metrics/microstructure of the spinal cord. Furthermore, the DTI parameter of FA at apical level was associated with GK and sagittal DAR. Level of evidence 4.

In a sample of common two-banded sea bream, Diplodus vulgaris, collected from the northern coast of Tunisia, one specimen displayed abnormal morphology. This individual presented a prominently developed upper margin, arched into a hump, a pointed upper head profile, and a strongly curved lateral line. X-ray imaging revealed abnormal curvatures in the vertebral column, such as hyperkyphosis and lordosis. A length-weight relationship analysis based on 49 normal specimens and the abnormal specimen showed a slightly negative allometry, suggesting that such specimens are capable of living alongside normal population in the wild.

SummaryHyperkyphosis commonly affects older persons and is associated with morbidity and mortality. Many have hypothesized that hyperkyphosis increases fall risk. Within this prospective study of older adults, kyphosis was significantly associated with incident falls over 1 year. Measures of hyperkyphosis could enhance falls risk assessments during primary care office visits.IntroductionTo determine the association between four measures of kyphosis and incident and injurious falls in older persons.MethodsCommunity-dwelling adults aged 65 and older (n = 72) residing in southern California were invited to participate in a prospective cohort study. Participants had kyphosis assessed four ways. Two standing measures included a flexicurve ruler placed against the back to derive a kyphotic index and the Debrunner kyphometer, a protractor used to measure the kyphotic angle in degrees. Two lying measures included the blocks method (number of 1.7 cm blocks needed to achieve a neutral head position while lying supine) and traditional Cobb angle calculation derived from DXA based lateral vertebral assessment. Baseline demographic, clinical, and other health information (including a timed up and go (TUG) test) were assessed at a clinic visit. Participants were followed monthly through email or postcard for 1 year, with falls outcomes confirmed through telephone interview.ResultsMean age was 77.8 (± 7.1) among the 52 women and 20 men. Over 12 months, 64% of participants experienced at least one incident fall and 35% experienced an injurious fall. Each standard deviation increase in kyphosis resulted in more than doubling the adjusted odds of an incident fall, even after adjusting for TUG. Odds of injurious falls were less consistent across measures; after adjusting for TUG, only the blocks method was associated with injurious falls.ConclusionsEach kyphosis measure was independently associated with incident falls. Findings were inconsistent for injurious falls; the blocks measure suggested the strongest association. If these findings are replicated, the blocks measure could be incorporated into office visits as a quick and efficient tool to identify patients at increased fall risk.

Purpose Thoracic hyperkyphosis (THK) is a prevalent spinal deformity in adolescents, which can impair respiratory function by affecting diaphragm morphology and thoracic mechanics. This study investigates the relationship between THK and diaphragmatic thickness using ultrasonography (USG) to explore its diagnostic and therapeutic implications. Methods This prospective study included 25 adolescents with THK and 29 healthy controls. Diaphragmatic thickness was measured using ultrasonography at the end of inspiration and expiration, and spirometry was conducted to assess respiratory function. Thoracic hyperkyphosis was diagnosed based on Cobb angle measurements. Statistical analysis included regression and ROC analyses to determine predictors of THK and evaluate diagnostic accuracy. The study was approved by the local Ethics Committee of the University of Healthy Science, Gaziosmanpasa Training and Research Hospital (IRB number: 109, date: 16 August 2023). The study protocol was registered to the clinicaltrial.gov.tr (NCT06418334 and initial release date: 01/11/2024). Results Adolescents with THK exhibited significantly higher Cobb angles (59.3 ± 7.9°) compared to controls (34.6 ± 3.7°, p  < 0.001). Diaphragmatic thickness during inspiration (2.5 mm vs. 3.1 mm, p  = 0.125) and expiration (1.50 mm vs. 1.56 mm, p  = 0.965) was lower in the THK group, with significant reductions in thickening ratio (1.76 ± 0.29 vs. 1.98 ± 0.30, p  = 0.008) and thickening fraction (DTf) (75.4% vs. 97.6%, p  = 0.008). A negative correlation was observed between Cobb angle and diaphragmatic thickening ( r =-0.378, p  = 0.005). ROC analysis indicated that USG parameters, particularly thickening fraction (AUC = 0.72, p  = 0.002), are reliable predictors of THK. Conclusion Adolescents with THK demonstrate reduced diaphragmatic thickness and impaired respiratory function. Ultrasonography emerges as a valuable, non-invasive tool for early diagnosis and monitoring of THK, offering potential for timely intervention to mitigate respiratory complications.

Purpose The aim was to assess the clinical outcomes after posterior spinal fusion (PSF) in patients with Scheuermann’s disease (SD). Methods SD undergoing PSF were retrospectively analyzed. Clinical outcome was determined using SRS-22- and Eq. 5D-questionaires preop and after 3, 12, 24 months after surgery. Whole spine x-rays were analyzed (preop, postop, after 6, 12, 24 months): sagittal and coronary Cobb angles, and pelvic parameters were evaluated; ideal lumbar lordosis (LL) was calculated using formula of le Huec (LL = 0.54*PI + 27.6). Surgical time, complications and blood loss were compared. Postop appearance of proximal (PJF) and distal junction failure (DJF) were calculated. Values were given as mean. Comparison with significance α = 0.05. Results 73 patients were included. SRS-22 total score and EQ5D showed significant increase from preop to two-year FU (each p  < 0.001). Preop Thoracic kyphosis (TK) was 75.1° with significant correction to 48.5° ( p  < 0.001). LL showed mean correction from 68.2° to 46.7° ( p  < 0.001). Difference between ideal and measured LL showed improvement from − 17.2° preop to -3.3° 6 month postop, good spontaneous correction of hyperlordosis. 63% had < 10° deviation from ideal LL 6 month postoperatively, whereas only 21.4% were in this range preoperatively. No significant changes for spinopelvic parameters during FU. Complications occurred in 13,7% of cases. A low revision rate for PJF (2,7%) was necessary. Subscore mental health showed a correlation to preop TK ( p  < 0.05). Conclusion Physiological reconstruction of sagittal alignment could be achieved in most cases (63%). Clinical FU results were convincing with significant improvement of patient’s satisfaction. Complication rate was moderate and risk of PJF after PSF low.