Scheuermann’s kyphosis in adolescents and adults: diagnosis and management.

Tribus CB. J Am Acad Orthop Surg 1998 Jan-Feb;6(1):36-43

Scheuermann’s thoracic kyphosis is a structural deformity classically characterized by anterior wedging of 5 degrees or more of three adjacent thoracic vertebral bodies. Secondary radiographic findings of Schmorl’s nodes, endplate narrowing, and irregular endplates confirm the diagnosis. The etiology remains unclear. Adolescents typically present to medical attention because of cosmetic deformity; adults more commonly present because of increased pain. The indications for treatment are similar to those for other spinal deformities, namely, progression of the deformity, pain, neurologic compromise, and cosmesis. The adolescent with pain associated with Scheuermann’s kyphosis usually responds to physical therapy and a short course of anti-inflammatory medications. Bracing has been shown to be effective in controlling a progressive curve in the adolescent patient. For the adult who presents with pain, the early mainstays of treatment are physical therapy, anti-inflammatory medications, and behavioral modification. In patients, either adolescent or adult, with a progressive deformity, refractory pain, or neurologic deficit, surgical correction of the deformity may be indicated. Surgical correction should not exceed 50% of the initial deformity. Distally, instrumentation should be extended beyond the end vertebral body to the first lordotic disk to prevent the development of distal junctional kyphosis.

2) Scheuermann’s disease.

Fiirgaard B, Agertoft A. Ugeskr Laeger 1990 Sep 24;152(39):2843-6

Scheuermann’s disease is most frequently diagnosed in patients between 13 and 17 years and is subdivided into high, long and low kyphoses. The symptoms consist of pain which may be aggravated by physical exertion. Pain is most frequent and most severe in the long and low kyphoses. The etiology and pathogenesis are not entirely elucidated but it is probable that there is a genetic component, that the condition is not unifactorial and that it may be due to weakness in the epiphyseal plates of the vertebrae. Radiography reveals irregularities of the end-plates of the vertebrae, frequently with Schmorl’s impressions, narrowing of the intervertebral spaces, one or more wedge-shaped vertebral bodies and increased kyphosing. No effective symptomatic treatment is known but the patients should be advised about choice of career and work. In order to avoid hyperkyphosis and chronic pain, back and abdominal musculature must be strengthened and mobility in the spine improved. Gymnastics, swimming and cycling on stationary bicycles may be recommended but sports associated with jumping and marked stress for the spine must be warned against. In few and severe cases, treatment with a corset or operation may be necessary.

1) Scheuermann’s disease.

Lowe TG. Orthop Clin North Am 1999 Jul;30(3):475-87, ix

Scheuermann’s disease is the most common cause of structural kyphosis in adolescence. The mode of inheritance is likely autosomal dominant and the etiology remains largely unknown. Indications for treatment remain controversial because the true natural history of the disease has not been clearly defined. Brace treatment appears to be very effective if the diagnosis is made early. Surgical treatment is rarely indicated for severe kyphosis (> 75 degrees ) with curve progression, refractory pain, or neurologic deficit.

Scheuermann’s kyphosis.

Ali RM, Green DW, Patel TC. Curr Opin Pediatr 1999 Feb;11(1):70-5

Scheuermann’s disease is a kyphotic deformity of the spine that develops in early adolescence. This condition has been reported to occur in 0.4% to 8% of the general population, with an equal distribution between sexes. Diagnosis of Scheuermann’s disease is suggested on clinical examination; however, parents of children affected often confuse it with poor posture. Radiographs are the standard imaging modality used to confirm the diagnosis of Scheuermann’s disease. Classic signs include vertebral end plate irregularity, disk space narrowing, and anterior wedging of involved vertebral bodies. Other diagnostic tools such as CT scans or magnetic resonance imaging may also be of value in the evaluation of Scheuermann’s disease. The mode of treatment for this condition depends upon the severity of the deformity, remaining growth, and presence or absence of symptoms. Early treatment may be limited to observation and exercises, whereas patients who have kyphosis of up to 75 degrees and how have growth remaining may benefit from bracing. Surgical correction is reserved for severe cases that are symptomatic and refractory to conservative management.