Surgery for abnormal kyphosis is usually the last treatment option tried; non-surgical treatments, such as physical therapy, should be tried first. If the pain and other symptoms don't lessen after several months of non-surgical treatments, the doctor may suggest surgery. Other criteria taken into consideration for abnormal kyphosis surgery are:

• Curve severity: Curve severity is dependent on where your spine has the hyperkyphotic curve. In the mid-back (thoracic spine), curves greater than 80° are considered severe; in the mid-back to low back region (thoracolumbar), curves greater than 60°-70° are severe. A thoracolumbar curve will give a patient a more severe and noticeable deformity; that's why they're considered severe at 60°-70°.
• Curve progression: If the curve is getting worse rapidly, despite non-surgical treatments, the doctor may recommend surgery to correct the curve and prevent it from getting worse.
• Balance: Leaning forward so far can affect your balance, so if the curve is making it difficult for you to get through your daily life because you're off balance, you may need surgery to rebalance the spine.
• Neurological symptoms: Kyphosis can affect the spinal nerves because changes in the spine—such as vertebral fractures—can cause pinched nerves. You may have weakness, numbness, or tingling, and in severe cases, when surgery is recommended, you may have bowel or bladder dysfunction.

Surgery for abnormal kyphosis has several main goals:

• Reduce deformity
• Reduce pain and any neurological symptoms
• Prevent the curve from getting worse

Based on these goals and your particular case, the surgeon will make the best recommendation for surgery. Some typical surgeries used for kyphosis are:

• Osteotomy: During an osteotomy, bone is cut to correct angular deformities. The bone ends are realigned and allowed to heal. Spinal instrumentation and fusion may be combined with an osteotomy to stabilize the spine during healing (see below).
• Spinal Instrumentation and Fusion: Once the spine has been realigned through an osteotomy, the surgeon will need to stabilize it to help the spine heal in the new position. To do this, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using donor bone as well) or a biological substance (which will stimulate bone growth). The fusion will stop movement between the vertebrae, providing long-term stability.
  
  Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability as the bones fuse. After surgery, the instruments cannot be seen, as they are small and are inside your body.

The surgeon may choose to perform your surgery from the front (anterior approach), the back (posterior approach), or a combination (anterior-posterior approach). The surgical approach will be chosen based on the location and severity of the kyphotic curve.

Balloon Kyphoplasty: A Special Surgery for Kyphosis Caused by Spinal Fractures
Balloon kyphoplasty is used only for abnormal kyphosis caused by spinal fractures. It's a minimally invasive treatment, meaning that it's performed through very small incisions. Minimally invasive surgeries also have a shorter recovery time than traditional surgeries. In balloon kyphoplasty, a special orthopaedic balloon is inserted into your collapsed vertebra. It's inflated in an attempt to return the vertebra to the correct height and position. The balloon creates a void—a hole—in your vertebra, and it's removed. The void is then filled with a surgical cement, which should support the vertebra and keep it from collapsing again.

Important Surgical Note
Even if the surgeon recommends surgery, you aren't required to go through with it. Always ask the purpose of the operation, results you can expect, and possible complications. Feel free to ask for a second opinion; this is your right. Your doctor should be happy to refer you to a specialist to re-evaluate your condition and help you make an informed decision about your treatment.

Surgical Risks
Any type of surgery has inherent risks. Abnormal kyphosis surgery in adults comes with great risk for nerve injury, so before deciding to have surgery, you should weigh the possible benefits. If the benefits outweigh the risks, then you should seriously consider surgery.

Your doctor will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:

• injury to your spinal cord or nerves
• non-healing of the bony fusion (pseudoarthrosis)
• failure to improve
• instrumentation breakage/failure
• infection and/or bone graft site pain

Complications could lead to more surgery, so again—make sure that you completely understand your surgery and the risks before proceeding. The decision for surgery is yours and yours alone.

Recovery from Kyphosis Surgery
After surgery, you should expect some pain and/or discomfort for a while, especially if you had a "traditional" surgery (osteotomy and fusion). Often, for the first days following surgery, Patient Controlled Analgesia (PCA) is used to control pain. A PCA machine enables you to determine when you'll receive pain medication through a needle in your arm. Such "patient control" helps to ensure that you never need be in significant pain when recovering from the surgery.

Usually, within a few days of your surgery, your doctor will refer you to a physical therapist who will create a customized program for you. The program's goals will be to carefully and steadily build your strength, flexibility, and range of motion. You will continue physical therapy for some time and most likely be given exercises to do at home.