Scheuermann's Kyphosis

1. See Also
   1. Pediatric Back Pain
2. Epidemiology
   1. Most common structural kyphosis in teenagers,with typical onset age 10-12 years old
3. Pitfalls
   1. Often misdiagnosed as poor Posture (postural kyphosis)
4. Pathophysiology
   1. Vertebral end plate disorder results in Vertebral body wedging
   2. With growth spurt, kyphosis increases
5. Signs
   1. Rigid kyphosis (humback deformity) that does not improve with back extension
6. Differential Diagnosis
   1. Congenital kyphosis (formation or segmentation failure in development)
   2. Neuromuscular kyphosis (Cerebral Palsy, Myelomeningocele, Syringomyelia, polio)
   3. Postural kyphosis
7. Imaging
   1. Thoracolumbar Xray
      1. Lateral: Diagnosis requires 5 degrees or more of wedging in at least 3 adjacent Vertebrae
      2. Also evaluate for Scoliosis and disc space narrowing
8. Management
   1. Bracing indications
      1. Kyphosis 55-80 degrees before skeletal maturity
   2. Surgery indications
      1. Kyphosis >80 degrees in Thoracic Spine
      2. Kyphosis >65 degrees in thoracolumbar spine
      3. Progressive or refractory course resulting in pain, neurologic deficit or balance concerns
9. Course
   1. Progression is most pronounced during growth spurt and then slows after reaching skeletal maturity
10. References
    1. Lowe (2007) Neurosurg Clin N Am 18(2): 305-15