Scheuermann's Kyphosis

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Scheuermann’s kyphosis, or Sheuermann’s disease, is a type of abnormal kyphosis (spinal curve) that develops in some adolescents.  The disorder causes patients to appear stooped, pitched forward, or bent over because of excessive thoracic kyphosis (hyperkyphosis).  The thoracic spine is the area between the shoulders and waist. Abnormal kyphosis can cause a humpback or hunchback.  The disorder is not caused by poor posture and is more common in boys.

 

There are different types of abnormal kyphosis and Scheuermann’s kyphosis is sometimes referred to as a primary curve.  This means the kyphosis is not caused by another disorder.

 

Unlike a postural curve, which is flexible and caused by poor posture, Scheuermann’s kyphosis is a structural curve, which means the patient cannot self-correct the abnormal curvature.  Sometimes, a structural curve displays a sharp, angular pattern called a gibbus, or hump.

Signs and Symptoms

Scheuermann's disease often first appears during adolescence at the time of puberty.  Parents typically bring their child in to see the doctor with a complaint of poor posture or slouching, sometimes with sporadic occurrences of fatigue and mild pain in the thoracic area of the spine.  In severe cases, young patients may have other symptoms including:

 

  • Pain
  • Rigid spinal curve worsened by bending forward, which partially corrects itself when standing
  • Co-existing scoliosis
  • Chest pain, difficulty breathing caused by decreased lung capacity; only in rare circumstances

 

Video: Kyphosis
Click below to view a video from our library about this condition.

 

Cause

The exact cause or causes of Scheuermann’s kyphosis is unknown.  There may be patterns in families.  Some specialists believe the disorder is related to vertebral body wedging that may occur during adolescent growth.  Instead of the vertebrae growing rectangular in shape, some develop wedge-shaped causing the spine to angle forward.
 

Development of Schmorl’s nodes may affect the vertebral endplates and body shape.  Schmorl’s nodes are cartilaginous growths that protrude through the disc affecting the contour of the spine.

 

Both vertebral wedging and Schmorl’s nodes are seen on x-ray.

Diagnosis

Scheurmann’s kyphosis requires an expert diagnosis which may involve these steps:

 

  • Medical History

The spine expert considers the patient's medical history, symptom onset, and severity.

 

  • Physical Examination

The physical and neurological examination includes assessing cardiopulmonary function (heart, lungs), movement limitations, balance problems, reflexes, muscle weakness, and sensation.

 

  • Adam’s Forward Bending Test 
    Bending forward at the waist helps to reveal a thoracolumbar kyphosis.  Thoracolumbar means the thoracic and lumbar spinal regions.

 

  • Palpation 
    A hands-on spinal examination reveals abnormalities by touch.  If Scheuermann’s disease exists, the thoracic spine is curved forward.

 

  • Range of motion (ROM)
    ROM measures the degree a patient can bend forward, backward, and side-to-side.

 

  • X-rays
    Full-length standing anterior/posterior (front/back), supine (lying face up) and lateral (side) x-rays of the entire spinal column are taken. X-rays help reveal vertebral body wedging and Schmorl’s nodes.  Abnormal curvature is measured on the x-rays.  If necessary, the doctor may order an MRI for more detailed information about the spine.   

Scheuermann’s kyphosis may be diagnosed if the patient has:

  • A kyphotic curve is 50-degrees or greater
  • Three or more adjacent vertebrae wedged together by at least a 5-degree segment (a total of 15-degrees across 3 segments).  
  • Schmorl’s nodes

Non-operative Treatment

The treatment plan for Scheuermann’s kyphosis depends on the patient’s age, curve size, and neurological problems (uncommon).  Non-operative treatment includes:

 

  • Curve observation
  • Bracing to help prevent curve progression
  • Physical therapy to increase range of motion, strength, and flexibility
  • Regular exercise for cardiovascular health

Surgical Treatment

Surgery may be recommended if:

 

  • The kyphotic curve exceeds 70-degrees
  • Neurological problems develop (uncommon)
  • Pain is severe and not relieved by non-operative treatment
  • Difficulty breathing (cardiopulmonary function)

 

Surgery may include spinal instrumentation and fusion.  The procedure may involve a posterior (back) and anterior (front) approach to the spine.  The surgeon may remove one or more intervertebral discs (discectomy) or bone (osteotomy) to help correct spinal alignment.  To stabilize the spine, instrumentation (i.e., rods, screws) and fusion (bone graft) is combined to affix the spine into better alignment.

 

It usually takes several months for a fusion to heal. Your surgeon decides if a post-operative brace is needed and how long it will take you (or your child) to heal / fuse.  Periodic pos-toperative x-rays are taken to monitor bone healing and fusion.

Recovery

Surgery to treat Scheuermann’s kyphosis is a major procedure and full recovery often takes months.  Before surgery, your surgeon explains the benefits, risks, and what to expect before, during and after surgery.