- 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); -
associatted 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; ---------------------------------------
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. Bradford DS, Ahmed KB, Moe JH: The surgical management of patients with Scheuermann's disease. J Bone Joint Surg (Am) 1980;62A:705. Bradford DS: Vertebral osteochondrosis (Scheuermann's kyphosis). Clin Orthop 1981;158:83-90.
