Scheuermann Kyphosis Workup

  • Author: Clifford Tribus, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: Sep 30, 2010
 

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.
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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.
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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.

Specialty Editor Board

Lee H Riley III, MD  Chief, Division of Orthopedic Spine Surgery, Associate Professor, Departments of Orthopedic Surgery and Neurosurgery, Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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; DePuySpine 2009 Consulting fee Design of Offset Modification of Expedium

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

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.

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. Tsirikos AI. Scheuermann's Kyphosis: an update. J Surg Orthop Adv. Fall 2009;18(3):122-8. [Medline].

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

  8. 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].

  9. 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].

  10. 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].

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

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

  13. 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].

  14. 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].

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

  16. 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].

  17. 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].

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

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

  20. de Mauroy J, Weiss H, Aulisa A, Aulisa L, Brox J, Durmala J, et al. 7 th SOSORT consensus paper: conservative treatment of idiopathic & Scheuermann's kyphosis. Scoliosis. May 30 2010;5(1):9. [Medline].

  21. Zaina F, Atanasio S, Ferraro C, Fusco C, Negrini A, Romano M, et al. Review of rehabilitation and orthopedic conservative approach to sagittal plane diseases during growth: hyperkyphosis, junctional kyphosis, and Scheuermann disease. Eur J Phys Rehabil Med. Dec 2009;45(4):595-603. [Medline].

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

  23. 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].

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

  25. 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].

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

  27. 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].

  28. 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].

  29. 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].

  30. Denis F, Sun EC, Winter RB. Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spine (Phila Pa 1976). Sep 15 2009;34(20):E729-34. [Medline].

  31. Daniels AH, Jurgensmeier D, McKee J, Harrison MW, d'Amato CR. Acute celiac artery compression syndrome after surgical correction of Scheuermann kyphosis. Spine (Phila Pa 1976). Feb 15 2009;34(4):E149-52. [Medline].

 
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Preoperative lateral of a patient with an 85° thoracic deformity secondary to Scheuermann kyphosis.
Postoperative lateral demonstrating a 2-rod leverage technique after an anterior release allowing reduction of the deformity to 47°.
 
 
 
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