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Scheuermann's Kyphosis
Aka: Scheuermann's Kyphosis, Scheuermann's Disease, Scheuermann Kyphosis
- See Also
- Pediatric Back Pain
- Epidemiology
- Most common structural kyphosis in teenagers,with typical onset age 10-12 years old (as early as 8 years old)
- Pitfalls
- Often misdiagnosed as poor Posture (postural kyphosis)
- Pathophysiology
- Osteochondrosis affecting the Vertebral epiphyseal Growth Plates
- Vertebral end plate disorder results in Vertebral body wedging
- With growth spurt, kyphosis increases
- Symptoms
- Stooped Posture
- Upper back pain
- Gradual onset
- Worse at end of day
- Relieved with rest
- Signs
- Rigid kyphosis (humpback deformity) that does not improve with back extension or lying supine
- Diagnosis
- Three or more adjacent Vertebrae wedged >5 degrees and thoracic disc space narrowing
- Draw lines from parallel to the top and bottom of the Vertebral bodies extended anteriorly
- Measure wedging angle at the point at which the 2 lines intersect
- Lines do not intersect in a normal, non-wedged Vertebrae
- Differential Diagnosis
- Congenital kyphosis (formation or segmentation failure in development)
- Neuromuscular kyphosis (Cerebral Palsy, Myelomeningocele, Syringomyelia, polio)
- Postural kyphosis
- Imaging
- Thoracolumbar Xray
- Lateral: Diagnosis requires 5 degrees or more of wedging in at least 3 adjacent Vertebrae
- Also evaluate for Scoliosis and disc space narrowing
- Thoracolumbar MRI
- Indicated in severe symptoms and non-diagnostic XRay
- Management
- Physical Therapy
- Bracing indications
- Kyphosis 55-80 degrees before skeletal maturity
- Surgery indications
- Kyphosis >80 degrees in Thoracic Spine
- Kyphosis >65 degrees in thoracolumbar spine
- Progressive or refractory course resulting in pain, neurologic deficit or balance concerns
- Restrictive Lung Disease related symptoms and signs
- Course
- Progression is most pronounced during growth spurt and then slows after reaching skeletal maturity
- References
- Achar (2020) Am Fam Physician 102(1):19-28 [PubMed]
- Lowe (2007) Neurosurg Clin N Am 18(2): 305-15 [PubMed]