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Patient Stories

Back Pain: Bad Posture or a Different Problem?


One patient moves past years of poor posture and pain.

As a child, Rwan Youssef grew accustomed to everyone telling her to sit up straight to correct her poor posture. 

“No one understood that I wasn’t slouching on purpose. It was how I had to sit in order to be comfortable,” says Youssef, 31. “It was actually painful for me if I tried to straighten my back. Various doctors told me it was just my posture.” 

After Youssef gave birth to her second child in 2019, she began to experience non-stop back pain. “If I lifted my baby, my back would hurt so much, I’d have to put him down,” says Youssef, who lives with her husband and two children in Shelton and is pursuing her master’s degree in special education. 

Her primary care physician recommended physical therapy. When it didn’t help, Youssef started to research spine doctors. In the fall of 2020, she made an appointment with Daniel Rubio, MD, a Yale Medicine orthopaedic spine surgeon.

“He did an X-ray and said, ‘It looks like you have Scheuermann’s kyphosis,’” Youssef recalls.

That she had a lot of pain and difficulty lifting her child and objects during daily life made sense [because of her condition].

Daniel Rubio, MD, Yale Medicine orthopaedic spine surgeon

It was the first time Youssef had heard of the condition, which is a deformity of the middle part of the spine. Scheuermann’s kyphosis causes the spine to curve forward excessively, sometimes to the point of creating the appearance of a hump. 

The causes of Scheuermann’s kyphosis are unknown. Scheuermann’s is a form of structural kyphosis in which the bone and intervertebral discs form an exaggerated “hump” during development of the spine. This structural kyphosis is typically identified during adolescence and can be progressive and painful into adulthood. 

The human spine curves naturally, determined by the relationship between the pelvis and spine as they develop together, Dr. Rubio explains. In Youssef’s case, her pelvis tilted in a such a way that her thoracic region should have been 55 to 60 degrees—but was actually at 80 degrees, Dr. Rubio says.

“That she had a lot of pain and difficulty lifting her child and objects during daily life made sense,” he says. 

Now that she had a diagnosis, Dr. Rubio suggested she try physical therapy one more time, along with lidocaine injections, before considering surgery. Youssef gave it another go, but when the pain didn’t subside, she decided to have surgery. 

The surgery, which took place in January of this year, lasted over several hours. Dr. Rubio used a technique called posterior column osteotomy, in which entire pieces or sections of bone are removed to allow the release of the spine and to create proper alignment. 

“I removed multiple joints to free up the spine, inserted a large metal rod to correct the shape, and fused it. With fusion, you are simulating what would happen to the body if you broke a bone naturally," he says. "If you broke your forearm, your body would send blood to the area to stimulate new bone growth. I use instruments that stimulate that growth. Then, we add metal rods and screws to hold the area in place while it fuses and her body forms new bone.” 

Dr. Rubio fused Youssef’s entire thoracic (middle) spine to the middle of her lumbar (lower) spine in her lower back. “The alignment is nearly perfect. I was aiming for 55 to 60 degrees, to restore her normal anatomy—and I got it there,” Dr. Rubio says. “You can see a drastic change in her X-rays.” 

Youssef and her sons, Aly and Badr Ibrahim, at Riverview Park in Shelton, Conn.

When she left the hospital, Youssef needed to use a walker while she healed, but now she’s walking and driving normally. She was instructed to avoid bending over and lifting anything heavier than 20 pounds for the six months following her surgery, at which point her back should be fully healed. 

Because the thoracic spine does not usually move as much as the rest of the spine, Dr. Rubio says he expects she will not see a significant decrease in her loss of motion after her fusion. She also can look forward to a life free of pain. 

As for Youssef, the surgery has been life-changing. “I look different and I feel different and it’s a relief to have found out there was something wrong with my spine, and it was not something was doing wrong,” she says.