Initial pre-referral workup

Clinical history

Standard history.

Back pain is a common feature of patients with increased kyphosis.

Physical examination

Look for kyphotic prominence on forward bend.

Investigations

Patient should have a standing X-ray of their complete spine both PA and lateral to assess for abnormal curvature. If in the Greater Melbourne area, it is preferable to get an EOS scan as this will have reduced radiation for the patient.  EOS is available at the RCH, Bridge Rd Imaging, and Mulgrave Private Hospital and all EOS sites are bulk billed.

GP management

Postural kyphosis or ‘slouching’ that can be corrected with patient prompting does not require referral to a spinal specialist. Management should focus on core stability work, physiotherapy, and conservative management of back pain symptoms.

If patient has thoracic kyphosis less than 60 degrees – they are within normal range and no referral is required.

Indications for specialist referral

All patients require an x-ray demonstrating abnormal spinal curvature prior to referral.

Routine

• thoracic kyphosis greater than 60 degrees
• short/sharp kyphosis with any underlying congenital spinal anomaly
• Kyphosis of the lumbar spine
• age older than 17 – not suitable for the RCH, refer to an adult institution.
• any Kyphosis associated with an underlying syndrome (e.g. neurofibromatosis, achondroplasia) in a patient younger than 18 years old should be referred