Kyphosis Surgery New York City | Dr. Zeeshan Sardar

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Co-Chief of Spinal Deformity Surgery • Director, Quality & Patient Safety • Medical Director, Spine Unit
Och Spine Hospital at NewYork-Presbyterian / Columbia University • New York, NY

Kyphosis — an excessive forward rounding of the spine — exists on a spectrum. At one end is the mild, stable roundback that requires only observation and physical therapy. At the other is a severe, rigid, progressive deformity that robs patients of the ability to stand upright, compresses the spinal cord, and steadily narrows the world they can navigate. For patients with significant, symptomatic kyphosis who have exhausted conservative options, surgical correction can restore alignment, relieve symptoms, and return function that many assumed was permanently lost.

Dr. Sardar specializes in the full spectrum of kyphosis surgery — from Scheuermann’s disease in adolescents and young adults to postoperative kyphosis after prior spine surgery, hyperkyphosis from osteoporotic fractures, and the rare but technically demanding cases of congenital and post-traumatic kyphosis. He performs the complete range of correction techniques, including Ponte osteotomies, pedicle subtraction osteotomy (PSO), and vertebral column resection (VCR), with robotic navigation and continuous intraoperative neuromonitoring as standard.

WHAT KYPHOSIS DOES TO DAILY LIFE

The clinical description of kyphosis — an excessive forward curve of the spine — understates what patients actually experience. What the condition does in practice is force the body into an impossible negotiation: the spine curves forward, shifting the center of gravity in front of the pelvis, and every moment of standing and walking becomes a muscular effort to compensate. Patients tilt their pelvis backward, bend their knees, extend their hips, and recruit every available muscle just to keep from falling forward. For a while this works. Then it stops working well enough.

Patients with progressive kyphosis describe a recognizable trajectory: the walk gets shorter, the standing time shrinks, upright social situations become exhausting and then avoided. Many have been told for years that this is simply how it is — that aging, degeneration, or a prior surgery left them this way and nothing further can be done. For a significant subset of these patients, that is not accurate. When the right diagnosis is made, the right evaluation is completed, and the patient is appropriately selected for surgery, the improvement in upright posture and functional capacity can be transformative.

WHAT IS KYPHOSIS?

The thoracic spine (mid-back) normally curves gently forward — between 20 and 45 degrees is considered the normal range on a standing X-ray. When this forward curve exceeds 50 degrees, it is classified as kyphosis. The visible consequence is a rounded or humped upper back. As the curve increases in severity, the compensatory demands on the rest of the spine and the lower extremities increase correspondingly, eventually producing the full clinical picture of progressive disability.

Kyphosis is not a single condition. It is a deformity — a shape problem — that can arise from multiple different underlying causes. The type of kyphosis determines the natural history, the likelihood of neurological involvement, the timing of surgical consideration, and the technical approach to correction.

TYPES OF KYPHOSIS

Scheuermann’s Kyphosis

The most common structural cause of kyphosis in adolescents and young adults. Scheuermann’s kyphosis occurs when the front edges of multiple consecutive vertebrae fail to grow at the same rate as the back edges during development, producing wedge-shaped vertebrae that cause the thoracic spine to curve forward into a fixed, rigid deformity. Unlike postural roundback, Scheuermann’s kyphosis does not correct with postural effort — the structural change is in the shape of the vertebrae themselves.

Curves typically develop during the adolescent growth spurt (ages 12–17) and are more common in males. The thoracic variant — the classic form — affects T7–T9 most commonly and produces the visible rounded upper back. A less common thoracolumbar variant causes lower back pain in young athletes. Surgery is considered for curves of 70 degrees or more, or for smaller curves with significant pain or neurological compromise. A comprehensive dedicated discussion is on the Scheuermann’s Kyphosis Surgery page.

Postoperative Kyphosis

Kyphosis that develops as a complication of prior spine surgery is one of the most underrecognized patterns in spinal deformity. It occurs when laminectomy disrupts the posterior tension band, when an inadequate fusion construct fails to maintain correction, when adjacent segments above a prior fusion progressively decompensate (proximal junctional kyphosis), or as a late consequence of Harrington rod instrumentation eliminating lumbar lordosis. Postoperative kyphosis may be progressive — and the natural history without treatment is often continued deterioration. Surgical correction requires careful evaluation of the prior construct, the anatomy available for revision instrumentation, and the type and location of osteotomy needed.

Hyperkyphosis in Older Adults (Degenerative and Osteoporotic)

Progressive hyperkyphosis in adults over 60 is most often driven by osteoporotic vertebral compression fractures, multilevel disc degeneration, or both. Compression fractures — which are often silent initially — collapse the anterior vertebral body, producing a wedge-shaped vertebra that contributes to progressive kyphosis with each new fracture. Multiple fractures across the thoracic spine accumulate into clinically significant deformity over years. For mild to moderate disease, osteoporosis treatment, extension-based therapy, and fracture management are the primary interventions. For severe, progressive, or neurologically compromised cases, surgical correction is considered in appropriately selected patients — age alone is not an absolute contraindication.

Cervical Kyphosis

When the normal lordotic (inward) curve of the cervical spine is lost and the neck develops a forward-bending kyphosis instead, the spinal cord is placed under progressive stretch across the kyphotic apex. Cervical kyphosis can produce or worsen myelopathy through a distinct mechanism from disc herniation, and decompression alone without correcting the kyphosis is often insufficient. Causes include multilevel laminectomy (post-laminectomy kyphosis), degenerative collapse, congenital anomalies, and inflammatory arthritis. Correction requires combined anterior and posterior approaches in most cases and continuous intraoperative neuromonitoring throughout.

Congenital Kyphosis

Kyphosis present from birth due to abnormal vertebral development. Some congenital kyphosis patterns are stable; others are progressive and carry significant risk of spinal cord compression. The Type I pattern (failure of formation — a hemivertebra or absent vertebral segment) is particularly prone to progression and myelopathy. Early surgical intervention is often recommended to prevent neurological injury in progressive congenital kyphosis, particularly when the pattern and the patient’s age suggest a high risk of cord compression over the growth period.

Post-Traumatic Kyphosis

Vertebral fractures from trauma, osteoporosis, or pathological causes that heal in a kyphotic position can produce symptomatic post-traumatic kyphosis. When the deformity causes pain, instability, or neurological compromise, surgical correction and stabilization may be needed. The approach depends on the level and severity of the deformity, the time elapsed since the original fracture, and the neurology.

SYMPTOMS

  • Visible roundback or hump — most apparent when bending forward; in severe cases visible while standing
  • Progressive difficulty standing upright — patients lean forward at rest and require increasing muscular effort to maintain upright position
  • Pain and fatigue — mid-back pain and exhaustion with standing or walking, from continuous compensatory muscular effort
  • Progressive decline in walking tolerance — distances that were manageable a year ago are now impossible
  • Respiratory symptoms — chest tightness or reduced exercise tolerance in severe thoracic kyphosis from reduced chest cavity volume
  • Neurological symptoms — leg weakness, numbness, gait instability, hand clumsiness (in cervical kyphosis), or bowel/bladder changes from spinal cord compression

EVALUATION

  • Full-length standing X-rays (36-inch cassette) — measuring the kyphosis angle, sagittal vertical axis (SVA), lumbar lordosis, thoracic kyphosis, and pelvic parameters; the standing X-ray is the primary surgical planning tool because it shows the spine under load with full compensation
  • Flexibility assessment (hyperextension X-ray) — distinguishing flexible from rigid deformity directly determines whether posterior-only correction is achievable or whether osteotomy is required
  • MRI — evaluating spinal cord signal, disc degeneration, neural compression, and the condition of posterior elements
  • CT scan — in revision or complex cases, assessing bony anatomy, fusion integrity, hardware condition, and bone quality at instrumentation sites
  • Bone density assessment — DEXA scan and CT Hounsfield units to evaluate osteoporosis; critical for implant planning and determining whether preoperative bone-building therapy is needed

NON-SURGICAL TREATMENT

Non-surgical management is appropriate and often sufficient for mild to moderate kyphosis:

  • Physical therapy — extension-based exercises strengthening the spinal extensors and improving thoracic mobility; cannot correct structural deformity but meaningfully reduces pain and slows functional decline
  • Bracing — most effective in skeletally immature patients with Scheuermann’s kyphosis; can remodel wedged vertebrae if begun with significant growth remaining; used primarily for progression control
  • Osteoporosis treatment — the single most important modifiable risk factor in degenerative hyperkyphosis; bone-building medications reduce fracture risk and can prevent further kyphosis accumulation
  • Pain management — anti-inflammatory medications, activity modification, and targeted interventional procedures for acute pain

SURGICAL CORRECTION — THE OSTEOTOMY

Kyphosis surgery requires careful matching of technique to pathology. Flexible deformities respond to instrumentation and positioning; rigid deformities require controlled bone cuts — osteotomies — to allow the spine to be repositioned into corrected alignment. The specific osteotomy is chosen based on the degree of correction required, the rigidity of the deformity, and the anatomy available.

Posterior Spinal Fusion for Flexible Kyphosis

When a kyphosis is partially or substantially correctable on hyperextension X-ray, posterior instrumented fusion — pedicle screws and rods applied from behind — can achieve good correction using the flexibility of the disc spaces as the corrective mechanism. The instrumentation holds the spine in the corrected position while fusion consolidates. This approach is most commonly used for moderate Scheuermann’s kyphosis and postoperative kyphosis with preserved disc flexibility.

Ponte Osteotomies

Ponte osteotomies are posterior-element releases performed at each stiff level of the kyphotic segment. By removing a small wedge of bone from the posterior elements — the spinous process, portions of the lamina, and the facet capsule — the surgeon releases the posterior tension that prevents the curve from correcting fully during rod application. Multiple Ponte osteotomies across the apex of the kyphosis each contribute approximately 5 to 10 degrees of incremental correction, and the cumulative effect can often achieve excellent correction of moderate Scheuermann’s kyphosis through a posterior-only approach — avoiding the additional morbidity of an anterior procedure.

Pedicle Subtraction Osteotomy (PSO)

For rigid kyphosis — where the anterior disc spaces are fused or otherwise incapable of hinging during correction — the pedicle subtraction osteotomy is the workhorse procedure. A PSO is a three-column osteotomy performed entirely through a posterior approach: the posterior elements, both pedicles, and a precisely calculated wedge of vertebral body are removed at a single level. When the posterior gap is closed during rod application, the spine hinges through the vertebral body itself, providing 30 to 40 degrees of correction at a single level without requiring any disc space mobility.

PSO is the standard approach for rigid postoperative kyphosis and for Harrington rod-related flatback deformity where the anterior disc spaces are solidly fused. It is technically demanding: the vertebral body wedge must be precisely and uniformly removed, the spinal cord sits immediately posterior throughout the procedure, and the correction maneuver must be controlled and gradual. Robotic navigation and continuous intraoperative neuromonitoring are non-negotiable in PSO at this practice. Cell salvage is used as standard to reduce transfusion requirements in this blood-loss-significant procedure.

Clinical reference: Sardar ZM, Kim Y, Lafage V, Rand F, Lenke L, Klineberg E; SRS Adult Spinal Deformity Committee. State of the art: proximal junctional kyphosis — diagnosis, management and prevention. Spine Deform. 2021;9(3):635–644. PMID 33452631 — Dr. Sardar co-authored this SRS-commissioned state-of-the-art review of PJK diagnosis, management, and prevention.

Vertebral Column Resection (VCR)

Complete removal of one or more vertebral bodies, including the anterior and posterior elements, through a posterior approach or a combined anterior-posterior approach. VCR provides the greatest correction of any osteotomy technique and is reserved for the most severe, rigid, or sharply angular deformities — including severe congenital kyphosis, post-traumatic kyphosis with a fixed angular deformity at a single level, and cases where PSO alone cannot achieve the correction necessary. VCR carries the highest surgical risk of any correction technique and is performed only at high-volume deformity centers with the full supportive infrastructure.

Combined Anterior-Posterior Approach

For very large or very rigid curves — particularly severe Scheuermann’s kyphosis in adults or severe post-traumatic deformity — a combined approach may be used: anterior disc release or corpectomy to improve flexibility, followed by posterior instrumented correction. With modern pedicle screw fixation and the availability of PSO, combined approaches are used more selectively than in prior decades, but they remain an important option for the most challenging deformities.

PREOPERATIVE OPTIMIZATION

Kyphosis correction surgery — particularly PSO and VCR — is among the most physiologically demanding procedures in elective spine surgery. Preoperative optimization is not optional; it is a meaningful factor in outcome. The following are systematically addressed before surgery:

  • Osteoporosis. Patients with significant osteoporosis are treated with bone-building medications (teriparatide or romosozumab) for 3 to 6 months before elective surgery to improve bone quality, screw purchase, and fusion rates. Skipping this step in osteoporotic patients is one of the most preventable causes of hardware failure after kyphosis correction. See Osteoporosis & Spine Surgery for detailed information on this component.
  • Nutritional status. Albumin and prealbumin levels predict wound healing and infection risk. Nutritional supplementation is initiated early when deficiency is identified.
  • Cardiovascular clearance. Major osteotomy procedures carry significant physiological demand. Cardiac assessment and exercise tolerance are standard.
  • Smoking cessation. Smoking is strongly associated with pseudarthrosis. Cessation before surgery meaningfully improves fusion rates.

RECOVERY

  • Hospital stay: Typically 3–6 days depending on complexity and osteotomy type
  • Mobilization: Patients are up and walking the day after surgery
  • Visible posture change: Many patients notice they can stand more upright within days of surgery — this is often one of the most emotionally significant moments of the recovery
  • Return to light activity: Typically 4–8 weeks
  • Return to work: Sedentary roles typically 6–8 weeks; physical roles 3–6 months
  • Fusion maturation: 12 to 18 months for complete consolidation, though functional improvement is well underway long before that point

WHAT TO LOOK FOR IN A KYPHOSIS SURGEON

Kyphosis correction is performed infrequently even at major spine centers. The specific techniques — Ponte osteotomies, PSO, VCR — apply different forces to the spine than scoliosis correction does, require specific instrumentation strategies, and carry neurological risks that demand continuous real-time monitoring throughout. Before choosing a surgeon, these are the questions worth asking:

  • Do you use continuous intraoperative neuromonitoring throughout the entire case? IONM is non-negotiable for kyphosis correction. The spinal cord is at greatest risk at the apex of the kyphosis, precisely where the corrective forces are applied. Any surgeon performing this operation should use full four-limb monitoring throughout — not spot-checks or partial-case monitoring.
  • How many PSO or VCR procedures do you perform per year? These are high-stakes operations with outcomes that directly correlate with surgeon and center volume. A meaningful answer is a number, not a generality about experience.
  • Do you use robotic navigation for instrumentation? PSO and VCR involve placing screws in distorted, scarred, or osteoporotic anatomy. Robotic navigation significantly reduces the risk of malpositioned hardware in this setting.
  • Is this performed at a center with a dedicated deformity program? The infrastructure — deformity-experienced anesthesia, intraoperative CT, cell salvage, a dedicated neuromonitoring team, and critical care with familiarity with this patient type — matters as much as the surgical skill in a procedure of this complexity.

FREQUENTLY ASKED QUESTIONS

Is my kyphosis severe enough to need surgery?

Most patients with kyphosis do not need surgery. Surgery is generally considered when the curve is severe (over 70–75 degrees for Scheuermann’s), causing significant symptoms that have not responded to conservative treatment, or when there is neurological involvement. The right question is not just the degree on X-ray but the trajectory: is it getting worse, and is the quality-of-life impact significant? A formal evaluation answers both.

What is a pedicle subtraction osteotomy and do I need one?

A PSO is a three-column osteotomy performed from the back — removing the posterior elements, pedicles, and a wedge of vertebral body at one level to achieve 30 to 40 degrees of correction through bone rather than disc space. It is needed when the kyphosis is rigid — when the disc spaces will not flex enough to allow adequate correction through posterior instrumentation alone. The flexibility assessment on your hyperextension X-ray determines this.

Can kyphosis cause paralysis?

Severe or rapidly progressive kyphosis can compress the spinal cord, causing myelopathy — leg weakness, gait instability, bowel or bladder dysfunction, and in severe cases, paralysis. This is particularly relevant in cervical kyphosis and severe congenital kyphosis. Myelopathy from kyphosis is a surgical urgency; if you are experiencing these symptoms, seek evaluation promptly rather than waiting for a scheduled appointment.

Will kyphosis get worse without treatment?

It depends on the type. Scheuermann’s kyphosis typically stabilizes once skeletal maturity is reached, though severe curves may continue to worsen slowly in adulthood. Degenerative and osteoporotic kyphosis can progress significantly with each additional compression fracture. Postoperative kyphosis is often progressive if the underlying structural problem is not addressed. Serial standing X-rays over time are the only way to determine whether your curve is stable or progressing.

I was told surgery is too risky at my age. Should I get a second opinion?

Yes. Age alone is not a contraindication to kyphosis surgery. The relevant factors are overall health, bone quality, cardiac and pulmonary reserve, and the degree of functional impairment from the deformity. Patients in their 60s and 70s with preserved functional status and appropriate medical condition undergo major kyphosis correction with good outcomes when carefully selected and thoroughly optimized. A second opinion at a high-volume deformity center is always appropriate before accepting that nothing can be done.

What is the difference between kyphosis and scoliosis?

Scoliosis is an abnormal side-to-side (coronal plane) curvature. Kyphosis is an abnormal front-to-back (sagittal plane) curve — specifically, excessive forward rounding. The two frequently coexist in the same patient, and managing both simultaneously requires comprehensive three-dimensional deformity planning.

RELATED CONDITIONS & RESOURCES

When kyphosis surgery requires thoracic or lumbar fusion, the surgical plan at this practice goes beyond standard rod-and-screw technique. Depending on the complexity of the deformity and the anatomy encountered, Dr. Sardar’s approach incorporates robotic CT-based preoperative planning with MEANS-derived sagittal alignment targets, custom-contoured rods manufactured to the planned correction, patient-specific interbody cages designed from the patient’s own CT scan, and — for cases with severely altered posterior bone anatomy — Firefly® patient-specific navigation guides. This ultra-personalized approach means every implant and every correction target is matched to the individual patient’s anatomy, not sized from a standard catalog on the day of surgery.

About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, Chair of the IMAST Committee of the Scoliosis Research Society, and Co-Chair of the NASS Deformity Section. He performs the full range of kyphosis correction procedures — Ponte osteotomies, PSO, and VCR — with robotic navigation and continuous intraoperative neuromonitoring as standard. To schedule a consultation or request a second opinion, call 212-932-5187 or visit the contact page. Telemedicine available in NY, NJ, CT, FL, PA, MO, CA, and TX.

This page is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition.

Reviewed by Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C — Last reviewed: August 2026.