Definition:

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.

Incidence:

It ranges between 1 and 8% of the general population.
The ratio of boys/girls is 2-7/1.

Clinical presentation:

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).

Special investigations:

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 scoliosis.

Natural history:

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.

Treatment:

1. Non-operative:

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.