eMedicine Specialties > Orthopedic Surgery > Spine

Scheuermann Kyphosis: Follow-up

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

Outcome and Prognosis

Outcome and prognosis depend on the individual patient and treatment rendered. Generally, a patient with moderate to mild Scheuermann kyphosis (Scheuermann disease) rarely requires surgery or even bracing. These patients can be managed with education, guidance, and overall encouragement to resume and maintain normal activity levels. The aggressive use of exercise and judicious use of anti-inflammatory medications can augment this regimen.

The outcome and prognosis of bracing treatment is more controversial. While the brace is in place, approximately a 50% correction of the deformity should be expected. However, once the brace is removed, a gradual loss of correction is expected over time.

Sachs et al reported on 120 patients reviewed 5 years following discontinuation of bracing.20 Sixty-nine percent of these patients had maintained at least 3° of improvement over their presenting radiographs. Other authors have presented similar results. Sachs also reported that the prognosis was less favorable if the presenting curve was 74° or more. One third of these patients failed bracing therapy and progressed to needing surgery.

The current literature is devoid of patient-based outcome studies in patients who have undergone surgical correction of Scheuermann kyphosis. While authors report high satisfaction rates, no papers have adequate control subjects. However, retrospective reviews with high patient satisfaction ratings should not be ignored.

Surgical correction of the deformity affords predictable restoration of normal thoracic kyphosis, thus halting progressive deformities. Reasonable pain relief and resumption of normal activities also are reflected in multiple retrospective reviews.

Future and Controversies

Current controversies in the treatment of patients with Scheuermann kyphosis (Scheuermann disease) revolve around bracing care and the surgical decision making process. Proponents of bracing state that bracing postpones indefinitely the need for surgical intervention. Bracing nihilists believe that bracing does not affect the ultimate prognosis of the curve and that, if these patients are monitored long enough, the curve continues to settle and resumes its prebracing course of progression.

Surgical care for patients with Scheuermann kyphosis also is somewhat controversial. Murray et al9 reported on 76 patients with a mean kyphosis angle of 71°, monitored for an average of 32 years. None of these patients underwent operative treatment. In comparing their quality of life to age-matched controls, no significant differences were encountered in level of education, number of days absent from work due to low-back pain, extent of pain that interfered with activities of daily living, presence of numbness in the lower extremity, self-consciousness, self-esteem, social limitations, use of medications for back pain, or level of recreational activities. However, these patients did report more intense back pain. 

Patients in the Murray et al study9  also tended to have jobs with lower requirements for physical activity. They had less range of motion and reported a different localization of their pain. This study has been criticized because of its lack of a surgical patient population as a control. Additionally, the average of 71° generally was deemed low compared to surgical groups.

The future of the care for patients with Scheuermann kyphosis will mirror the evolution of the generalized care of patients with spine abnormalities. Dynamic instrumentation systems are being used, and improving surgical techniques with biological manipulation are almost certain to become mainstream treatment options.

 


More on Scheuermann Kyphosis

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Follow-up: Scheuermann Kyphosis
Multimedia: Scheuermann Kyphosis
References
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References

  1. Sorensen KH. Scheuermann's Juvenile Kyphosis: Clinical Appearances, Radiography, Aetiology, and Prognosis. Copenhagen: Munksgaard, 1964.

  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.

  4. Fon GT, Pitt MJ, Thies AC Jr. Thoracic kyphosis: range in normal subjects. AJR Am J Roentgenol. May 1980;134(5):979-83. [Medline].

  5. Shelton YA. Scoliosis and kyphosis in adolescents: diagnosis and management. Adolesc Med State Art Rev. May 2007;18(1):121-39, x. [Medline].

  6. Scoles PV, Latimer BM, DigIovanni BF, et al. Vertebral alterations in Scheuermann''s kyphosis. Spine. May 1991;16(5):509-15. [Medline].

  7. Bradford DS, Moe JH, Montalvo FJ, et al. Scheuermann''s kyphosis and roundback deformity. Results of Milwaukee brace treatment. J Bone Joint Surg Am. Jun 1974;56(4):740-58. [Medline].

  8. Bradford DS, Moe JH, Montalvo FJ, et al. Scheuermann''s kyphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients. J Bone Joint Surg Am. Jun 1975;57(4):439-48. [Medline].

  9. Murray PM, Weinstein SL, Spratt KF. The natural history and long-term follow-up of Scheuermann kyphosis. J Bone Joint Surg Am. Feb 1993;75(2):236-48. [Medline].

  10. Halal F, Gledhill RB, Fraser C. Dominant inheritance of Scheuermann''s juvenile kyphosis. Am J Dis Child. Nov 1978;132(11):1105-7. [Medline].

  11. Skogland LB, Steen H, Trygstad O. Spinal deformities in tall girls. Acta Orthop Scand. Apr 1985;56(2):155-7. [Medline].

  12. Ascani E, Salsano V, Giglio G. The incidence and early detection of spinal deformities. A study based on the screening of 16,104 schoolchildren. Ital J Orthop Traumatol. Apr 1977;3(1):111-7. [Medline].

  13. Fotiadis E, Grigoriadou A, Kapetanos G, Kenanidis E, Pigadas A, Akritopoulos P, et al. The role of sternum in the etiopathogenesis of Scheuermann disease of the thoracic spine. Spine. Jan 1 2008;33(1):E21-4. [Medline].

  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].

  15. Gilsanz V, Gibbens DT, Carlson M, King J. Vertebral bone density in Scheuermann disease. J Bone Joint Surg Am. Jul 1989;71(6):894-7. [Medline].

  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].

  17. Ryan MD, Taylor TK. Acute spinal cord compression in Scheuermann''s disease. J Bone Joint Surg Br. 1982;64(4):409-12. [Medline].

  18. Lowe TG. Scheuermann disease. J Bone Joint Surg Am. Jul 1990;72(6):940-5. [Medline].

  19. Montgomery SP, Erwin WE. Scheuermann''s kyphosis--long-term results of Milwaukee braces treatment. Spine. Jan-Feb 1981;6(1):5-8. [Medline].

  20. Sachs B, Bradford D, Winter R, et al. Scheuermann kyphosis. Follow-up of Milwaukee-brace treatment. J Bone Joint Surg Am. Jan 1987;69(1):50-7. [Medline].

  21. Kostuik JP. Anterior Kostuik-Harrington distraction systems. Orthopedics. Oct 1988;11(10):1379-91. [Medline].

  22. Lowe TG, Kasten MD. An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann''s disease. A review of 32 patients. Spine. Aug 1 1994;19(15):1680-5. [Medline].

  23. Arlet V, Schlenzka D. Scheuermann's kyphosis: surgical management. Eur Spine J. Nov 2005;14(9):817-27. [Medline].

  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].

  25. Geck MJ, Macagno A, Ponte A, Shufflebarger HL. The Ponte procedure: posterior only treatment of Scheuermann's kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech. Dec 2007;20(8):586-93. [Medline].

  26. Lowe TG. Double L-rod instrumentation in the treatment of severe kyphosis secondary to Scheuermann''s disease. Spine. May 1987;12(4):336-41. [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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