Diagnostic Considerations

Differentiating normal thoracic kyphosis from abnormal thoracic kyphosis (Scheuermann kyphosis, or Scheuermann disease) is somewhat problematic. Normal thoracic kyphosis is actually dynamic throughout life and typically increases.

Fon et al measured thoracic kyphosis in 316 normal subjects (159 male, 157 female).^[22] In those younger than 10 years, the average kyphosis was 20.88° with a standard deviation (SD) of 7.85 for boys and 23.87° with an SD of 6.67 for girls. In adolescents, the kyphosis had increased to an average of 25.11° with an SD of 8.16 in boys and 26.00° with an SD of 7.43 in girls.

Females, on average, have slightly greater kyphosis in the thoracic spine throughout life, and this difference between males and females increases further when they are older than 40 years. Fon et al found that in women aged 50-59 years, the average kyphosis measured 40.71° with an SD of 9.88°, whereas men in the same age group had an average thoracic kyphosis of 33.00° with an SD of 6.46.^[22]

Shelton et al reported on the diagnosis and management of kyphosis in adolescents.^{[23, 24]}

For purposes of definition, any degree of kyphosis of more than 40° should be deemed abnormal. Additionally, any degree of kyphosis at the thoracolumbar junction or in the lumbar area of the spine should be considered abnormal.

Workup

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Media Gallery

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

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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, Scoliosis Research Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Kentucky Medical Association, North American Spine Society, Kentucky Orthopaedic Society, International Society for the Study of the Lumbar Spine, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, AOSpine, Cervical Spine Research Society, International Society for the Advancement of Spine Surgery, International Society for the Study of the Lumbar Spine, Lumbar Spine Research Society, North American Spine Society, Scoliosis Research Society, Society of Lateral Access Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic, Nuvasive, NLT Spine, RTI, Magellan Health<br/>Received consulting fee from Medtronic for consulting; Received consulting fee from NuVasive for consulting; Received royalty from Nuvasive for consulting; Received consulting fee from K2M for consulting; Received ownership interest from NuVasive for none.

Additional Contributors

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.

Scheuermann Kyphosis Differential Diagnoses

Diagnostic Considerations

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