Scheuermann’s Kyphosis

Background 

• Rigid spinal kyphosis cause by anterior wedging 
• Definition: Thoracic kyphosis with anterior wedging >5 degrees of at leas 3 consecutive vertebral bodies 
• Adolescents (onset age 10) 
• M>F 
• Autosomal Dominant 
• 2 forms 
  • Typical 
    • Apex T6-8, curve T1-L1 
    • Non structural lumbar hyperlordosis 
  • Atypical 
    • Apex TTL 
    • More progressive and sympomatic 

Pathophys 

• Unknown 
• Osteonecrosis of anterior apophyseal ring 
• Herniation of disc material leading to anterior disc height loss 
• Relative osteoporosis – compression 
• Altered biomechanics; anterior wedging and growth arrest 
• Collagen aggregation development error; abnormal end plate 

Associated 

• Lumbar lordosis 
• Spondylolisthesis 

Imaging 

• Findings 
  • Wedging 
  • Narrowed disc space 
  • Irregular end plates 
  • Schmorl nodes 
• Flexible vs Rigid – hyperextension lateral XR with bolster at apex 
• MRI – r/o disc herniation of other canal pathology which may cause cord compression with deformity correction 

Managementt 

• Kyphosis <60 – non op; includes Jewitt with high  chest pad brace (no correction but stops progression) 
  • Extensor strengthen, hamstring stretch 
• Kyphosis >60 
  • Cosmesis 
  • Pain 
• Surgery 
  • Posterior only 
    • PSIF with osteotomies  
    • Shorten posterior column too 
    • Use IONM 
  • Goal: T2 to first lordotic vertebra 45 degrees (normal is 20-40) 

Complications 

• Neurologic injury 
  • 1% 
  • Higher than scoliosis 
• DJK 
• PJK 
  • Overcorrecion 

Pearls 

• >85 leads to cardiorespiratory 
• Thoracic disc herniaion most common cause of neuro declines 
• Apical disc herniations and extra dural cyss a apex