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Update on Scheuermann's Kyphosis

Posted on: 11/15/2007
Doctors from the Mayo Clinic provide this review and update on a condition called Scheuermann's kyphosis. Kyphosis refers to a forward rounding of the thoracic spine. The deformity was first described by Dr. Scheuermann based on X-ray findings.

No one knows for sure yet just what causes this problem. Children between the ages 10 and 14 seem to be affected most often. Some reports suggest that boys are more likely than girls to develop Scheuermann's. But other studies report equal numbers between males and females.

The cosmetic appearance of a humpback usually brings children to the doctor. Sometimes there are complaints of back, buttock, and/ or leg pain. Sleep disturbance from pain that wakes them up is also common.

X-rays are still used to identify and measure the curve. Scheuermann's is diagnosed when the thoracic kyphosis is 40 degrees or more. Other findings include wedging along the anterior (front) portion of three or more vertebral bodies.

Disc spaces are narrowed and Schmorl's nodes may be present. Schmorl's nodes occur when the cartilage of the disc pushes through the vertebral body endplate and into the next vertebra.

Anyone with a curve that is 60 degrees and getting worse is a candidate for nonoperative care. Bracing can be used to control the deformity and restore the anterior vertebral height. Some children may need a series of body casts first before using a brace.

Surgery is advised when there is a progressive curve of 70-75 degrees. The kyphosis is rigid and does not correct (straighten), which causes an unacceptable cosmetic appearance. Kyphosis correction is achieved by lengthening the front of the spine. This is called an anterior release.

Shortening the posterior (back) column of the spine is the second step required. This can be done using a variety of fusion techniques described in detail. New technology has made it possible to fuse the spine without doing a combined anterior-posterior fusion procedure.

Amy L. McIntosh, MD, and Daniel J. Sucato. Scheuermann's Kyphosis. In Current Opinion in Orthopaedics. November 2007. Vol. 18. No. 6. Pp. 536-543.

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