Scheuermann's Kyphosis

- Discussion: 
      - most common cause of structural kyphosis of thoracic & thoracolumbar spine;
      - most commonly seen in skeletally immature adolescents; 
      - there is usually a strong hereditary tendency (may be autosomal dominant); 
      - etiology is not known; 
      - criteria for diagnosis: 
             - thoracic kyphosis > 45 deg (25 to 40 deg being normal);  
             - wedging > 5 deg of three adjacent vertebrae 
             - thoracolumbar kyphosis > 30 deg (thoracolumbar spine is normally straight); 
       - associated conditions: 
             - spondylolysis:
                      - scheurermanns' disease causes increased lumbar lordosis which strains L5 pars interarticularis; 
             - scoliosis: occurs in 25%; 

- Clinical Findings:
 
        - hyperkyphosis that doesn't reverse w/ hyperextension; 
        - tight hamstrings; 
        - poor posture; 
        - back pain located over apex of kyphosis; 
        - back pain involving lower lumbar spine when excessive lordosis is present; 
        - associated neurological deficits are uncommon; 
        - where as thoracic Scheurman's is not usually associated w/ pain, lumbar Scheurman's is often symptomatic; 

- Diff Dx:
 
        - postural roundback: 
        - these patients will have a flexible roundback and no wedging on x-rays; 
        - rickets 
        - juvenile osteoporosis 
        - neurofibromatosis 
        - Morquio's  
        - spondyloepiphyseal dysplasia tarda 

- Radiographs:
 
       - required views:  
             - lateral x-ray, made w/ pt lying supine over bolster; 
             - this will hyperextend spine, & will show if deformity is correctable; 
             - lateral standing view: required for diagnosis; 
- criteria for diagnosis: (lateral standing x-ray); 
       - thoracic kyphosis > 45 deg (25 to 40 deg being normal); 
       - thoracolumbar kyphosis > 30 deg (thoracolumbar spine is normally straight); 
       - wedging > 5 deg of three adjacent vertebrae 
       - kyphotic angle > than 45 degrees is considered to be abnormal; 
       - misc: - apex of the deformity is usually located at the level of T7 & T8; 
                - Schmorl nodes (end plate erosion) is a common finding; 
                - irregularity & flattening of vertebral end-plates
                - narrowing of vertebral disc spaces; 
                - varying degrees of Scoliosis in approx one-third of patients; 

- Non Operative Treatment:
 
        - natural history: pain usually subsides at end of growth unless deformity is severe; 
        - curve < 50 deg: 
        - young adolescents w/ kyphotic deformity of < 50 deg & no evidence of progression may be observed; 
        - exercise & stretching of hamstrings & back may prevent excessive lordosis and hamstring contractures; 
        - bracing to correct thoracic kyphosis may be useful in pts w/ pain; 
        - curve of 50 to 70 deg: 
        - braces are worn for 1 year around the clock & then at night for 2 years; 
        - unlike scoliosis, bracing after skeletal maturity may be effective, and permanent correction can be obtained; 
        - Milwaukee brace is required for thoracic curves; 
        - TLSO is required for curves below T-8; - progressive curve > 60 - 65 deg 
        - Milwaukee brace is required even if patient has no pain;
        - better prognosis for correction in skeletally immature patients; 
        - w/ good compliance in brace, expect correction of deformity at 1-2 years; 
        - misc: - hamstring stretching is useful in the presence of contracture; 

- Operative Treatment:
 
        - indications: - thoracic kyphosis > 75 deg 
        - persistent back pain that is unresponsive to non operative treatment; 
        - rigid kyphosis > 55 deg; 
                 - requires anterior release w/ interbody fusion followed by posterior fusion w/ compression instrumentation 



Scheuermann’s kyphosis; current controversies

The surgical management of patients with Scheuermann's disease: a review of twenty-four cases managed by combined anterior and posterior spine fusion

Scheuermann's kyphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients

Posterior fusion for Scheuermann's kyphosis 

Post-traumatic kyphosis. A review of forty-eight surgically treated patients

Scheuermann kyphosis. Follow-up of Milwaukee-brace treatment

The natural history and long-term follow-up of Scheuermann kyphosis

The surgical management of patients with Scheuermann's disease: a review of twenty-four cases managed by combined anterior and posterior spine fusion.

Vertebral osteochondrosis (Scheuermann's kyphosis).




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, April 13, 2012 2:50 pm