eMedicine Specialties > Orthopedic Surgery > Spine

Scheuermann Kyphosis: Workup

Author: Clifford Tribus, MD, Associate Professor, Department of Orthopedic Surgery and Rehabilitative Medicine, University of Wisconsin-Madison
Contributor Information and Disclosures

Updated: Sep 4, 2008

Workup

Laboratory Studies

  • At this point, no genetic markers or laboratory studies exist to assist the physician in confirming the diagnosis of Scheuermann kyphosis (Scheuermann disease). Should treatment be rendered, order the appropriate laboratory studies. For example, if anti-inflammatory medications are started, the appropriate monitoring laboratory studies should be followed. In addition, if surgical care is undertaken, routine preoperative laboratory studies are indicated.

Imaging Studies

  • Radiographs
    • A standard radiographic evaluation of a patient with Scheuermann kyphosis (Scheuermann disease) includes anteroposterior (AP) and lateral standing radiographs on long films, which would incorporate the entire thoracolumbar spine on one film. The patient should be standing in a neutral position with hips and knees fully extended to allow for a true evaluation of the sagittal balance.
    • The diagnosis of Scheuermann kyphosis is confirmed on the lateral radiographs. The angle between the endplates of each respective vertebral body should be measured using the Cobb technique. Three adjacent vertebral bodies with 5° of anterior wedging confirm the diagnosis of Scheuermann kyphosis.
    • The Cobb technique should be used to measure the overall degree of kyphosis of the thoracic spine. It is important to pick the appropriate vertebral bodies to measure the thoracic kyphosis. The end vertebral bodies, which are defined as the last vertebral body tilting into the kyphotic deformity, should be selected both proximally and distally. The levels of these particular vertebral bodies should be noted, as they are the same vertebral bodies that should be selected on subsequent films to ensure that the examiner is consistent in the evaluation.
    • Secondary changes of Scheuermann kyphosis should be noted, such as the presence of Schmorl nodes, irregular vertebral endplates, and disk space narrowing.
    • Scoliosis and spondylolisthesis have been associated with Scheuermann kyphosis. These should be documented on plain radiographs and treated as separate entities.
    • Other entities that share the differential diagnosis of Scheuermann kyphosis can be excluded radiographically as well. Congenital kyphosis, ankylosing spondylitis, multiple compression fractures, tumor, infection, tuberculosis, and postlaminectomy kyphosis can be distinguished by clinical history and confirmed by radiographic evaluation.
    • The dynamic quality of the kyphosis should be assessed to distinguish Scheuermann kyphosis from postural kyphosis. A lateral radiograph can be obtained in hyperextension. Should the deformity correct entirely, postural kyphosis is the most likely diagnosis, rather than Scheuermann kyphosis.
    • It is necessary to account for the rigidity of the curve in treatment decisions, as the ability for correction with bracing and surgical intervention will be affected.
  • MRI, CT scan, and CT myelography
    • MRI, CT scan, and CT myelography can be helpful adjunctive studies in planning the care of a patient with Scheuermann kyphosis.
    • MRI, in particular, helps the surgeon to further define the local anatomy. In particular, pay attention to the coexistence of thoracic spinal stenosis, syrinx, or any other intrathecal abnormalities that would affect surgical care.
    • Additionally, an anatomic assessment of the lumbar disks can be made and may impact surgical decision making in terms of which levels to incorporate in the fusion.

More on Scheuermann Kyphosis

Overview: Scheuermann Kyphosis
Workup: Scheuermann Kyphosis
Treatment: Scheuermann Kyphosis
Follow-up: Scheuermann Kyphosis
Multimedia: Scheuermann Kyphosis
References
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References

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  2. Lowe TG, Line BG. Evidence based medicine: analysis of Scheuermann kyphosis. Spine. Sep 1 2007;32(19 Suppl):S115-9. [Medline].

  3. Bradford DS, Lonstein JE, Moe JH, et al. Juvenile kyphosis. In: Moe's Textbook of Scoliosis and Other Spinal Deformities. 2nd ed. Philadelphia: WB Saunders Co;1987:347-368.

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  14. Bradford DS, Brown DM, Moe JH, et al. Scheuermann''s kyphosis: a form of osteoporosis?. Clin Orthop. Jul-Aug 1976;(118):10-5. [Medline].

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  16. Lonstein JE, Winter RB, Moe JH, et al. Neurologic deficits secondary to spinal deformity. A review of the literature and report of 43 cases. Spine. Jul-Aug 1980;5(4):331-55. [Medline].

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  24. Lee SS, Lenke LG, Kuklo TR, Valenté L, Bridwell KH, Sides B, et al. Comparison of Scheuermann kyphosis correction by posterior-only thoracic pedicle screw fixation versus combined anterior/posterior fusion. Spine. Sep 15 2006;31(20):2316-21. [Medline].

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Further Reading

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Keywords

scheuermann kyphosis, Scheuermann disease, scheuermann's disease, scheuermann's kyphosis, kyphosis, osteochondritis deformans, osteochondrosis, osteochondritis, kyphosis, thoracic kyphosis, SJK, Scheuermann juvenile kyphosis, spinal deformity, structural thoracic kyphosis, scoliosis, osteoarthritis, roundback, hunchback

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Contributor Information and Disclosures

Author

Clifford Tribus, MD, Associate Professor, Department of Orthopedic Surgery and Rehabilitative Medicine, University of Wisconsin-Madison
Clifford Tribus, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, North American Spine Society, and Scoliosis Research Society
Disclosure: Nothing to disclose.

Medical Editor

Lee H Riley III, MD, Chief, Division of Orthopedic Spine Surgery, Assistant Professor, Departments of Orthopedic Surgery and Neurosurgery, Johns Hopkins University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

William O Shaffer, MD, Professor, Vice-Chairman and Residency Program Director, Department of Orthopedic Surgery, University of Kentucky at Lexington
William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, and Southern Orthopaedic Association
Disclosure: DePuySpine 1997-2007 (not presently) Royalty Consulting; DePuySpine 2002-2007 (closed) Grant/research funds SacroPelvic Instrumentation Biomechanical Study; DePuyBiologics 2005-2008 (closed) Grant/research funds Healos study just closed; No present Industry grants or funds. None None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD, Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania
Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association
Disclosure: Nothing to disclose.

 
 
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