There are three types of spinal curvature: kyphosis, in which the spine of the upper back tilts forward; scoliosis, in which the spine curves either to the left or right; and lordosis, when the lower back arches outward. Such problems can either be present at birth or develop later.


Many people have a small amount of forward rounding of their upper back, but doctors don’t usually consider the problem to be kyphosis unless the degree of rounding is greater than 40 degrees. If the cause of kyphosis is long-standing poor posture or an underlying disease process, the degree of rounding is likely to increase and may cause painful symptoms.


When kyphosis is severe, symptoms may include not just a rounded back but also backache and some breathing difficulties. This last symptom is because the forward tilt of the spine pushes the ribs in toward the lungs and constricts their ability to expand.

What Causes Kyphosis?

When a curvature is present at birth, it’s likely that it’s been caused by a rare developmental problem that fused or distorted the baby’s vertebrae. Kyphosis may also develop during adolescence, especially in girls, when slouching posture stretches the ligaments that support the spine. Scheuermann’s  disease, a condition of unknown cause that runs in families and affects more boys than girls, may have the same effect. When kyphosis develops in adulthood, it is usually due to another condition, through poor posture also plays a part. The culprits may be osteoporosis, which sometimes leads to a dowager’s hump; osteoarthritis; rheumatoid arthritis; and ankylosing spondylitis. Occasionally, disorders that affect muscles and connective tissue or tumours may also be responsible.


Good posture is vitally important, especially during late childhood and adolescence, so encourage your children to adopt a correct posture. For adults, physiotherapy may be useful. If you think you’re developing kyphosis, consult a doctor.


Scoliosis Bending Down

While kyphosis is an outward and upward curve of the thoracic spine, scoliosis is a spinal curve in a different plane – either right or left of a normal spine, as seen from behind. In the classic manifestation of scoliosis, the spine comes to adopt either C or S shape.

Scoliosis affects about twice as many girls as boys, and is most likely to develop any time from early childhood through to adolescence.


Other than the curvature of the spine – and sometimes a difference in the apparent height of the shoulders or the hips – there are often no symptoms, though there may be some back pain. In severe cases, the curvature of the spine may affect the movement of the ribs and even the heart, causing shortness of breath and chest pain.

What Causes Scoliosis?

In about 80% pf cases, the cause of scoliosis is unknown, though the condition often runs in families. However, an apparent scoliosis can also result from muscular imbalances caused by poor posture, a discrepancy in leg length or overdevelopment of the muscles on one side of the spine, as is seen in some professional tennis players. Another type of scoliosis – generally referred to as functional scoliosis – can develop as a response to a painful stimulus, such as herniated disc. Or sometimes a severe form of the problem results from a defect in a way that the spinal bones develop in the womb (congenital scoliosis).

Osteoarthritis and osteoporosis can also cause scoliosis if the damage they cause mostly affects one side of the spine.


Scoliosis can generally be prevented only when it is caused by muscular imbalances that are created, and then worsened, by poor posture. In those instances, paying attention to your posture can help stave off the problem. Physiotherapy may help in this situation.

Figuring Out What’s Wrong

X-ray of the spine will be helpful to see the severity of the scoliosis.

Fixing The Problem

Functional scoliosis is treated by addressing the problem causing the muscular imbalance, often by means of physiotherapy. When scoliosis is idiopathic in a young person, a brace may be fitted to stop the curvature from becoming worse as growth continues. Surgery is generally advised for a young person if there are additional symptoms such as pain, breathing difficulty, or heart problems. Depending on the cause, this may involve the realignment of vertebrae followed by spinal fusion to fix them in place, or the removal of osteophytes – bony outgrowths from the vertebrae – formed as a result of osteoarthritis.



The left hand side of the picture shows a natural inward curve of the vertebral column in the lower back. In some people this becomes exaggerated, and in these cases the condition is known as lordosis.

Lordosis can cause pain and limit movement. It also reduces the spine’s efficiency as a shock absorber. As a result, even minor injury can cause damage to muscles, ligament, and vertebrae.

What Causes Lordosis?

Although lordosis tends to run in families, and in some cases can be present at birth as a result of developmental problems in the womb, most cases are caused by bad posture. The problem can also arise in later life as a result of a number of other conditions that cause degeneration of the spinal column, such as osteoarthritis and osteoporosis. Injury to the neck and back can also be a contributory factor.

What Are The Symptoms?

Apart from an unnatural and ungainly posture, neither cervical nor lumbar lordosis usually cause any symptoms, other than mild limitation in movement and sometimes mild discomfort. On rare occasions, severe lordosis may cause pressure on nerves as they leave the spinal cord, causing problems at the nerve’s root.


The most important preventive measure you can take is to be vigilant about maintaining good postures at all times, and to be ready to make necessary adjustments throughout the day.

Figuring Out What’s Wrong

Lordosis is diagnosed by observation and confirmed by X-rays. The doctor will also check on the range of movement of your spine to see if it has become limited in any way.

Fixing The Problem

Often mild lordosis does not require specific treatment. But if the condition is causing pain, you may be advised to take medication or injection. A physical therapy program may be suggested, with the aim of improving your range of movement.

The emphasis of treatment is on correcting your posture and maintaining the improvement by constant vigilance.

Spine Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

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Scoliosis is a problem with the curve in your spine. Some curves in your spine are normal. But a few people have spines that make a large curve from side to side in the shape of the letter “S” or the letter “C.” If this curve is severe, it can cause pain and make breathing difficult.

The good news is that most cases of scoliosis are mild. If found early, they can usually be prevented from getting worse.

Scoliosis Bending Down


What causes scoliosis?

Scoliosis usually starts in childhood. Scoliosis that is severe enough to need treatment is most common in girls.

A curve in the spine may get worse as your child grows, so it is important to find any problem early.

In most cases, the cause of scoliosis is not known. This is called idiopathic scoliosis. It develops mostly in children and teens and appears to be related to several things, including genetics, as it often runs in families.

There are two types of scoliosis: nonstructural and structural.

Nonstructural (functional) scoliosis

Nonstructural (functional) scoliosis involves a curve in the spine, without rotation, that is reversible because it is caused by a condition such as:

  • Pain or a muscle spasm.
  • A difference in leg length.

Structural scoliosis

Structural scoliosis involves a curve in the spine, with rotation, that is irreversible and is usually caused by an unknown factor (idiopathic) or a disease or condition such as:

  • Disorders that were present at birth (congenital), such as spina bifida, in which the spinal canal does not close properly; or a disorder that affects the formation of bones. These curves can be harder to correct. They often get worse as the child grows, especially during the teen years.
  • Nerve or muscle disorders, such as cerebral palsy, Marfan’s syndrome, or muscular dystrophy.
  • Injuries.
  • Infections.
  • Tumors.

In adults, scoliosis may result from changes in the spine due to aging (degenerative changes). These degenerative changes may be caused by osteoarthritis.

What are the symptoms?

Scoliosis most often causes no symptoms in your child until the spinal curve becomes large. You might notice these early signs:

  • Your child has one shoulder or hip that looks higher than the other.
  • Your child’s head does not look centered over the body.
  • Your child has one shoulder blade that sticks out more than the other.
  • Your child’s waistline is flat on one side, or the ribs look higher on one side when your child bends forward at the waist.

In adults, scoliosis may cause back pain and trouble breathing.

How is scoliosis diagnosed?

The doctor will check to see if your child’s back or ribs are even. If the doctor finds that one side is higher than the other, your child may need an X-ray so the spinal curve can be measured.

Scoliosis is most serious in young children who are still growing. A curve in the spine may get worse as your child grows. So many experts believe screening your child for scoliosis is important so that any curve in the spine can be found early and watched closely.

How is Scoliosis treated?

Mild cases of scoliosis usually do not need treatment. Your doctor will check the curve of your child’s spine every 4 to 6 months. If the curve gets worse, your child may need to wear a brace until he or she has finished growing. In severe cases, or if bracing doesn’t help, your child may need to have surgery.

Scoliosis and its treatment can be a severe strain on your child. Wearing a brace can feel and look odd. It also limits your child’s activity. Your child needs your support and understanding to get through treatments successfully.

What increases the risk of scoliosis?

Your child may be more likely to have scoliosis if someone in your family has had it and if your child is a girl. Other things that increase the chance of scoliosis include:

  • One of the bones in your child’s spine has moved forward out of place compared to the rest of the spine.
  • Your child’s arms or legs are missing or are abnormally short.
  • Your child has other problems with tissue growth that happened before birth.

When To Call a Doctor

Call your doctor to have your child evaluated for scoliosis if:

  • You observe a curve in your child’s spine.
  • You notice that something about your child’s posture looks unusual, such as ribs that stick out, one shoulder that is higher than the other, one hip that is higher than the other, or an uneven waistline.
  • You observe that your child’s clothes don’t fit properly or that his or her hems don’t hang evenly.
  • A school screening program recommends that your child see a doctor.

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What is scoliosis?


Scoliosis is a medical condition in which a person’s spine is curved from side to side, shaped like an “s” or “c”, and the spine may also be rotated.

How is scoliosis diagnosed?

A rib “hump” or a prominent shoulder blade caused by rotation of the ribcage in thoracic scoliosis can be detected on physical examination. It is more prominent when the patient is bent forward. A special X-ray film called a scoliosis film will confirm the diagnosis.

Causes of scoliosis

There is no definite cause but most are due to developmental problems.

Prevention of scoliosis

Regular exercise and a good diet. Scoliosis is more likely to occur to low body weight patients.

There is no way to prevent idiopathic scoliosis. Early detection and treatment, if necessary, helps to prevent it getting worse.

If you have a history of scoliosis in your family, children can be checked regularly for scoliosis from the age of nine throughout their teens.

Treatments for scoliosis

Treatments include monitoring with regular medical check up to look for worsening of the curvature, bracing to help moderate cases and surgery may be necessary for the severe cases.

Scoliosis Doctor

Dr Mathew Tung, Spinal Specialist

Dr Mathew Tung Neurosurgeon