A Gibbus Deformity is a form of structural kyphosis. The posterior (from behind) curve presents sharply angled; the curvature is not smooth. This deformity may result in a humpback found to be more prominent when bending forward.

This term is used to describe 'excessive' (hyper) curvature exceeding the normal range. Hyperkyphosis occurs in the thoracic spine. In adults, osteoporosis is a common cause often involving several vertebrae.

Congenital means the disorder is found at birth. Congenital kyphosis is a structural abnormality.

Scheuermann's Disease is juvenile (adolescent) thoracic kyphosis. Although the cause is unknown, it may be familial. This disease can cause decreased intervertebral disc space and vertebral wedging resulting in an excessive curve described as stiff or rigid. The classic definition of Scheuermann's is anterior (front) vertebral wedging of at least 5 degrees involving three consecutive vertebrae. The neck and head may present in an abnormal forward position. The onset usually begins (or is noticed) between the ages of 12 and 15 years affecting females more often than males. For many patients (up to 50%), pain is a common complaint.

Deformity and pain often motivates the patient to visit their physician. Early treatment is important to control curve progression especially in adolescents.

A thorough physical examination reveals a lot about the health and general fitness of the patient. The exam provides a baseline from which the physician can measure the patient's progress during treatment. The physical exam will include:

• Observation of the posture may reveal round-back or gibbus deformity. The sagittal balance or balance of the head and trunk over the pelvis viewing from the side can be assessed. Any associated scoliosis will be observed.
• Adam's Forward Bending Test requires the patient to bend forward at the waist. This may reveal a thoracolumbar kyphosis.
• Palpation determines spinal abnormalities by feel. Often the paraspinal musculature is tender. When Scheuermann's Disease is present, the hamstring muscles may be tight.
• Range of Motion measures the degree to which a patient can perform movements of flexion, extension, lateral bending, and spinal rotation. Asymmetry is also noted. The deformity is palpated during range of motion to assess flexibility or rigidity of the curve.
• Neurologic Evaluation
  A neurological evaluation includes an assessment of the following symptoms: pain, numbness, paresthesias (e.g. tingling), extremity sensation and motor function, muscle spasm, weakness, and bowel/bladder changes.
• Radiographs
  Full-length AP (anterior/posterior, front/back) x-rays are taken of the spinal column. The patient stands with arms extended forward while keeping the head erect. To determine curve flexibility, x-rays may be taken with the patient supine. These x-rays are used to evaluate vertebral wedging and end plate irregularities, characteristic of Scheuermann's Disease.

These deformities are often discovered when an x-ray is taken for other health concerns. The deformity may also be discovered because the patient has a head tilt, uneven shoulders, uneven waistline or if the shoulders are not entered above the pelvis. Along with other congenital problems (kidney).

Treatment depends on the kind of deformity, the severity of the deformity, the age of the patient and the potential for the deformity to worsen. Treatment includes observation for curve progression, bracing to slow curve progression or surgery to stop curve progression and to correct the deformities..