Kraus Back & Neck Institute: 281.446.3876(281.44.Neuro)

Conditions

Scheuermann's Kyphosis

Scheuermann's kyphosis, or Scheuermann's disease, is a type of abnormal kyphosis that develops in the thoracic spine of some adolescents. Your thoracic spine is the region between the shoulders and waist. Stooped, pitched forward, bent over posture, humpback or hunchback appearance is indicative of excessive thoracic kyphosis, or hyperkyphosis. Scheuermann's is not caused by poor posture and is more common in boys.

How it is different

Scheuermann's kyphosis is sometimes referred to as a primary curve. This means it is not caused by another disorder. Unlike a postural curve, which is flexible and caused by poor posture, Scheuermann's kyphosis is a structural curve. This means the patient cannot self-correct kyphosis. Sometimes, a structural curve displays in a sharp, angular pattern called a gibbus deformity, or hump.

Cause

It is not always known why Scheuermann's kyphosis develops. There may be patterns in families. Some specialists believe the disorder is related to vertebral body wedging that may occur during adolescent growth. Instead of the vertebrae growing rectangular in shape, some develop wedge-shaped, and cause the spine to angle forward.

Development of Schmorl's nodes may affect the vertebral endplates and body shape. Schmorl's nodes are cartilaginous growths that protrude through the disc and affect the contour of the spine. Vertebral wedging and Schmorl's nodes are seen on plain x-ray.

Symptoms

  • Back pain
  • Stiffness
  • Tender to the touch
  • Round back or humpback appearance (spinal deformity)
  • Clothing does not fit properly
  • Fatigue
  • Difficulty breathing (severe kyphosis)

Accurate diagnosis

The spine specialist's examination includes your medical history, physical and neurological examination, and imaging studies. Because some spine disorders run in families (inherited, genetic predisposition), your family history is important.

Physical examination provides the doctor with a general health and spinal assessment baseline to help estimate the possibility for kyphosis to progress.

  • Heart and lung function
  • Physical appearance (posture, humpback)
  • Palpation: feel the spine through the skin on the back
  • Range of Motion: flexion, extension, bending, rotating
  • Adam's Forward Bending test: bending forward at the waist with the arms extended forward, the doctor checks for shoulder blade, rib, or other prominence.

Neurologic examination is an assessment of your reflexes and tests for muscle weakness, loss of feeling, and signs of neurological injury.

A simple spinal x-ray can show Scheuermann's kyphosis. Typically, several x-rays are taken: side (lateral), standing (front and back), bending forward (flexion) and bending backward (extension). The flexion/extension studies help your spine specialist to evaluate your range of motion and spinal stability. Special measurement techniques are used to calculate the kyphotic curve's angle(s), patient's skeletal maturity, risk for progression, and other characteristics.

Other diagnostic imaging studies may include a CT or MRI series. A MRI study is of particular use to assess nerve and/or spinal canal (cord) compression. Your doctor will explain the purpose of these and other tests.

Scheuermann's kyphosis may be diagnosed if …

  • Kyphotic curve measures 50-degrees or greater
  • Three or more adjacent vertebrae are wedged together by at least a 5-degree segment (a total of 15-degrees across 3 segments).
  • Schmorl's nodes

Treatment

The treatment plan for Scheuermann's kyphosis depends on the patient's age, curve size, risk for progression (characteristics), and neurological dysfunction (rare).

  • Observe the curve
  • Spinal bracing to help prevent curve progression
  • Physical therapy to increase range of motion, flexibility, strength
  • Regular exercise to benefit cardiovascular health

Spine surgery may be recommended if …

  • The kyphotic curve exceeds 70-degrees
  • Neurologic dysfunction develops (rare)
  • Breathing is difficult (rare)
  • Pain is severe, not relieved with conservative care

Spine surgery often includes fusion and instrumentation to stop curve progression, manage deformity, provide a degree of correction, and stabilize the spine. You may be a candidate for a minimally invasive procedure. There are different ways the surgery can be performed, and your surgeon explains the possible benefits and risks associated with his surgical recommendations.

After surgery, you wear a special brace to support the spine while you heal. Your surgeon will tell you if a brace must be worn after surgery, and how long it can take for your spine to fuse (heal). Periodic post-operative x-rays are taken to monitor bone fusion.

We hope this information about Scheuermann's kyphosis has answered some of your immediate questions. Remember, your doctor is your most valuable source to answer your questions about symptoms and your spine health.

Gary Kraus, MD,
Neurosurgeon, is Board Certified
Meet Gary Kraus, MD
Masaki Oishi, MD,
Spine Fellowship at the University
Meet Gary Kraus, MD
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