Kyphosis, Scheuermann disease

• Kyphosis refers to the convex alignment in the sagittal plane of the thoracic spine.
• Normally, 20 to 40 degrees.
• Those who have increased kyphotic alignment have the clinical sign of roundback.
• Idiopathic roundback is referred to as Scheuermann disease.
   

Scheuermann disease

• is a fixed kyphosis that develops around the time of puberty. Anterior vertebral body wedging and narrowing of the thoracic intervertebral disc spaces on xray.
• It is caused by an anterior wedge-shaped deformity on one or more vertebrae, usually in the thoracic region, and affects 7% to 8% of the population.
• More common in teen males and weight-lifters
• Patients present with a complaint of poor posture and possibly fatigue or an aching sensation in the region of the kyphosis.
• Findings on physical examination include accentuation of the normal dorsal kyphosis, increased lumbar lordosis, and a protuberant abdomen.
• A definitive diagnosis is only possible if posteroanterior and lateral radiographs of the spine reveal vertebral wedging of greater than 5 degrees.
• 30-50% have associated Spondylolysis

Treatment of Scheuermann disease

• primarily a cosmetic problem, depends on several factors, including age of patient, duration of disease, degree of deformity, associated pain, and psychosocial factors.
• A patient who has a mature skeleton, is asymptomatic, and has a cosmetically acceptable appearance can be followed without treatment.
• The three effective treatments for kyphosis are bracing, casting, and surgery.
• The most effective is the Milwaukee brace, which generally is used to treat kyphotic deformities of greater than 60 degrees.
• Postural exercises may help to improve posture, but they will have no effect on correcting the deformity.
• Surgery usually is reserved for a patient who has a mature skeleton and a severe, painful deformity.
   

DDX

• Those who have postural kyphosis have round backs, but no radiographic vertebral abnormalities are evident.
• Diskitis is typically a disease of childhood, with about 75% of patients being younger than 10 years of age.
• Adolescents who have diskitis complain of back pain and maintain the spine in a straight, stiff position. The normal lumbar lordosis is reversed, and radiographs reveal disc space narrowing. 
• Pott disease is a late bone complication of tuberculosis that is characterized by destruction of the vertebral bodies and kyphosis.

Congenital vertebral deformities usually present with anterior  vertebraldefects at a younger age, especially when associated with other birth defects (eg, VATER/VACTERL syndrome or CHARGE syndrome).

References:
Murray PM, Weinstein SL, Spratt KF. The natural history and long-term
follow up of Scheuermann kyphosis. J Bone Joint Surg Am.
1993;75:236-248
Thomson GH, Scoles PV. Kyphosis (round-back). In: Behrman RE, Kliegman
RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed.
Philadelphia, Pa: WB Sanders Co; 2000:2086-2087

CHLA Board Review 2005