Scheuermann’s kyphosis is a thoracic hyperkyphosis (hump-back)
due to wedging of the thoracic vertebrae which develops in adolescence.
It is caused by softening of the cartilage of the vertebral bodies which
results in a wedge-shaped deformation of the vertebrae in the thoracic
spine and an increase of the kyphosis. An autosomal dominant pattern of
inheritance occurs. The kyphotic angle is 25° in normal teenagers
and 40° in normal adults.
It ranges between 1 and 8% of the general population.
The ratio of boys/girls is 2-7/1.
It affects the mid-thoracic or lower-thoracic spine and is usually associated
with a compensatory hyperlordosis of the cervical- and lumbar spine (hollowing
of the curves of the neck and low back). Tightness of the hamstrings is
common. Pain occurs in the region of the kyphosis or in the areas above
or below the main deformity (cervical- and lumbar spine).
There is a hyperkyphosis of the thoracic spine with a hyperlordosis of
the lumbar spine. There is wedging of more than 3 vertebrae with irregularly
narrowed disc spaces. A kyphotic angle of more than 45° during the
growth period is diagnostic. This is sometimes associated with a mild
Pain is common during the early teenage years and normally decreases
in late adolescence or early adulthood. It is benign condition in the
majority of cases. Respiratory problems may occur in very severe deformities.
This includes exercise and bracing. Exercise has not been shown to improve
the kyphotic angle. Bracing is of value only in patients with a mobile
deformity and with a sufficient amount of growth remaining. A kyphotic
angle of more than 75° will not respond to brace treatment. A brace
should be worn a minimum of 18 months to have an effect.
2. Operative treatment:
Neurological symptoms are an absolute indication. This occurs rarely.
Surgery should be considered if the kyphotic angle is more than 75°
in patients with chronic pain who do not respond to conservative treatment.
The cosmetic effect of the kyphosis also plays a role in decision making.
Because the natural history of Scheuermann’s is benign, surgery
can only be recommended on a case-by-case basis, considering its potential
complications. This is fairly extensive surgery that is performed from
posteriorly (through the back) and sometimes also through the chest. Screws
and rods are used to correct the deformity and fuse the spine
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