Scheuermann's Disease

History:The patient was a fifteen year old boy who according to the parents had developed progressive hunching of the back. This was not felt to be a pure posture problem due to the rigidity of the back and inability to correct the appearance of increased curvature by leaning backward. There was no significant associated pain or radiating symptoms to the arms or legs. There was also no family history of severe kyphosis.

Physical Examination:On examination, the patient was a well-developed adolescent standing with clearly increased kyphosis of the thoracic spine (upper back). Overall the patient was well balanced in frontal (seen from the front) and sagittal planes (seen from the side). There were no abnormal skin marking, patches or discolorations (which can be signs of neurofibromatosis, congenital anomalies or other underlying conditions). The thoracic kyphosis was rigid and offered no significant correction on hyperextension. Examination of the upper and lower extremities revealed no neurovascular deficits.

Radiographic Evaluation:Full-length standing x-rays of the spine were obtained. Globally the spine was well balanced with the head centered over the sacrum/pelvis. The thoracic kyphosis exceeded 90 degrees (normal ranges around 25-50 degrees). Additionally, wedging of the apical vertebrae in the thoracic kyphosis was noted (T8, T9,T10 levels). This confirms the diagnosis of Scheuermann's disease.

Treatment Options:Scheuermann's kyphosis can range in severity and in most cases the abnormal kyphosis is not very severe and can be treated non-operatively. Non-surgical options include observation and extension exercises for mild cases, and bracing for moderate and progressive cases. For bracing to be an effective modality, the kyphosis should optimally be less than 70 degrees and significant growth in the patient must still be present. Once growth has neared completion bracing is usually no longer effective.

Severe curvatures (kyphosis) may be best treated with surgery. If the spine is very rigid and/or the patient is very young with associated scoliosis, then anterior and posterior surgery may be necessary to obtain good correction and avoid continued spinal deformity (ex. Crankshaft). In curvatures that reveal some flexibility and are not associated with significant scoliosis (in a very young patient), surgical correction by a posterior approach alone can be considered.

Discussion:After thorough discussions with the patient regarding the treatment options, a decision was made to proceed with surgery. The kyphosis was severe and bracing was not felt to be a good option. By examination the kyphosis was felt to offer some flexibility and the scoliosis present was felt to be mild. In this setting a posterior approach alone was considered to be sufficient.

As planned, the patient was treated by posterior instrumented fusion after multi-level osteotomies were performed to obtain a balanced correction. The patient was discharged after a brief (4 day) hospital stay. On follow up evaluation he had maintained excellent balance and a correction of kyphosis to around 50 degrees.

Kyphosis Medical Condition

Scheuermann's Disease Medical Condition