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Description of the Symptom

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A parent may state that their child has "poor posture." That may represent the only way in which they can express their concern with their child's spinal shape. While poor posture is a culturally defined concept, scoliosis, kyphosis, and lordosis are significant medical concerns. Spinal curvatures are named for the direction of the convexity or apex and the spinal region (thoracic, lumbar, or cervical). Scoliosis is a lateral curvature of the spine and kyphosis and lordosis are curves in the anteroposterior plane. Kyphosis is a curve where the apex is posterior and lordosis where the apex is anterior.

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The thoracic spine is normally kyphotic. However, excessive kyphosis exceeding approximately 40 degrees is abnormal. In the thoracic spine kyphosis less than 40 degrees is normal but excessive lordosis, or insufficient kyphosis (less than 20 degrees), is abnormal.1 In the lumbar spine lordosis from approximately 30 to 50 degrees is normal.1 Greater lordosis is abnormal. In the lumbar spine kyphosis is always abnormal. This chapter will discuss poor posture under three separate headings: scoliosis, kyphosis, and lordosis (Figs. 59-1 and 59-2).

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FIGURE 59-1

Adolescent girl with scoliosis.

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FIGURE 59-2

Lateral curvatures of the spine. In front is an adolescent girl with normal thoracic kyphosis and lumbar lordosis. In the middle is a girl with increased thoracic kyphosis (thoracic hyperkyphosis). At the back is a girl with decreased thoracic kyphosis (thoracic hypokyphosis) and an increase in lumbar lordosis (lumbar hyperlordosis).

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This chapter describes possible causes of poor posture and scoliosis, kyphosis, and lordosis in a child.

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Special Concerns

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  • Any acute increase in scoliosis, kyphosis, or lordosis

  • Scoliosis, kyphosis, or lordosis associated with pain

  • Any curve associated with changes in the foot anatomy (especially cavovarus) suggesting intraspinal anomalies

  • Left thoracic scoliosis in adolescents

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CHAPTER PREVIEW: Conditions That May Lead to Poor Posture and Scoliosis, Kyphosis, or Lordosis in a Child

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