Kyphosis, Scheuermann disease
refers to the convex alignment in the sagittal plane of the thoracic spine.
20 to 40 degrees.
- Those who
have increased kyphotic alignment have the clinical sign of roundback.
roundback is referred to as 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
present with a complaint of poor
posture and possibly fatigue or an aching sensation in the region of
- Findings on
physical examination include accentuation of the normal dorsal
lumbar lordosis, and a
- 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
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
- 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
exercises may help to improve posture, but they will have no effect on
correcting the deformity.
usually is reserved for a patient who has a mature skeleton and a severe,
- 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.
who have diskitis complain of back
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
vertebral deformities usually present with anterior vertebraldefects at a
younger age, especially when associated with other birth defects (eg,
Murray PM, Weinstein SL, Spratt KF. The natural history and long-term
follow up of Scheuermann kyphosis. J Bone Joint Surg Am.
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