An abnormally increased anteroposterior curving of the dorsal spine causing a bowing of the back, usually at the thoracic level, commonly known as humpback or hunchback. The dorsal spine, also known as the thoracic spine, includes twelve dorsal or thoracic vertebrae (T1 to T12) that extend from the cervical vertebrae.

Kyphosis may be due to

• infection;

• inflammation;

• aseptic necrosis;

• aging and associated degeneration of intervertebral disks;

• atrophy;

• and osteoporosis (see Diagnostic Code: 5013) of the vertebrae.

Adult kyphosis may also result from endocrine disorders such as

• hyperparathyroidism (see Diagnostic Code: 7904);

• Cushing's disease (see Diagnostic Code: 7907); or

     other conditions such as arthritis (see Diagnostic Code: 5003),

• Paget's disease,

• poliomyelitis,

• compression fracture of the thoracic vertebrae,

• metastatic tumor,

• plasma cell myeloma, or tuberculosis (see Diagnostic Code: 6730).

It may also result from poor posture, which can stretch spinal ligaments, thus increasing the natural curve of the spine.

Manifestations include an obvious, outward curving of the back, possibly associated with pain, weakness of the back, and generalized fatigue. Dyspnea may be associated with a reduction in lung volumes resulting from inefficiency of muscular action of the chest wall. Frequent respiratory infections may lead to pulmonary complications and, eventually, to respiratory failure. Disk lesions called Schmorl's nodes may develop in anteroposterior curving of the spine. These nodes are localized extensions of material through the cartilage plates and into the spongy bone.

Physical examination reveals curvature of the thoracic spine in varying degrees of severity. Tests may be done to determine carbon dioxide and carbon dioxide retention. An x-ray may be done to evaluate for vertebral wedging, Schmorl's nodes, irregular end plates, and possible mild scoliosis of 10 to 20 degrees. Any curvature over 50 degrees is considered abnormal. Scheuermann Kyphosis is often associated with wedging in three or more adjacent vertebrae of more than five degrees.

Treatment depends on the cause and extent of the disorder. If kyphosis is caused by poor posture alone, treatment may consist of therapeutic exercises to help correct posture, bed rest on a firm mattress, and a brace to straighten the curve. Common exercises consist of pelvic tilt to decrease lumbar lordosis, hamstring stretch to overcome muscle contractures, and thoracic hyperextension to flatten the kyphotic curve. X-rays may be taken every 4 months to evaluate the curvature. Spinal arthrodesis may be performed to relieve symptoms. Surgery is rarely indicated in patients with Scheuermann Kyphosis.

In spite of therapy, there may be varying degrees of impaired physical mobility, and limited activities of daily living (ADL). If the Schmorl's nodes destroy the anterior portions of the cartilage, bridges of new bone may form across the intervertebral space causing ankylosis, which may cause stiffness or fixation.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Evaluate under the General Rating Formula for Diseases and Injuries of the Spine for diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.

• Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

• For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees (see forward flexion-cervical spine), extension is zero to 45 degrees (see extension-cervical spine), left and right lateral flexion are zero to 45 degrees (see lateral flexion-cervical spine), and left and right lateral rotation are zero to 80 degrees (see lateral rotation-cervical spine). Normal forward flexion of the thoracolumbar spine is zero to 90 degrees , extension is zero to 30 degrees (see forward flexion-thoracolumbar), left and right lateral flexion are zero to 30 degrees (see lateral flexion-thoracolumbar), and left and right lateral rotation are zero to 30 degrees (see lateral rotation-thoracolumbar spine.) The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

• In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.

• Round each range of motion measurement to the nearest five degrees.

• For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

• Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

• See Plate V found in 38 CFR 4.71a under The Spine section.