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

Sorensen KH. Scheuermann's Juvenile Kyphosis: Clinical Appearances, Radiography, Aetiology, and Prognosis. Copenhagen: Munksgaard; 1964.
Mansfield JT, Bennett M. Scheuermann Disease. Treasure Island, FL: StatPearls; 2021. [Full Text].
Lowe TG, Line BG. Evidence based medicine: analysis of Scheuermann kyphosis. Spine (Phila Pa 1976). 2007 Sep 1. 32 (19 Suppl):S115-9. [QxMD MEDLINE Link].
Juvenile kyphosis. Bradford DS, Lonstein JE, Ogilvie JW, Winter RB, eds. Moe's Textbook of Scoliosis and Other Spinal Deformities. 2nd ed. Philadelphia: WB Saunders; 1987. 347-68.
Bradford DS, Brown DM, Moe JH, Winter RB, Jowsey J. Scheuermann's kyphosis: a form of osteoporosis?. Clin Orthop Relat Res. 1976 Jul-Aug. (118):10-5. [QxMD MEDLINE Link].
Gilsanz V, Gibbens DT, Carlson M, King J. Vertebral bone density in Scheuermann disease. J Bone Joint Surg Am. 1989 Jul. 71 (6):894-7. [QxMD MEDLINE Link].
Halal F, Gledhill RB, Fraser C. Dominant inheritance of Scheuermann's juvenile kyphosis. Am J Dis Child. 1978 Nov. 132 (11):1105-7. [QxMD MEDLINE Link].
Skogland LB, Steen H, Trygstad O. Spinal deformities in tall girls. Acta Orthop Scand. 1985 Apr. 56 (2):155-7. [QxMD MEDLINE Link].
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. 1977 Apr. 3 (1):111-7. [QxMD MEDLINE Link].
Damborg F, Engell V, Nielsen J, Kyvik KO, Andersen MØ, Thomsen K. Genetic epidemiology of Scheuermann's disease. Acta Orthop. 2011 Oct. 82 (5):602-5. [QxMD MEDLINE Link]. [Full Text].
Hershkovich O, Friedlander A, Gordon B, Arzi H, Derazne E, Tzur D, et al. Association between body mass index, body height, and the prevalence of spinal deformities. Spine J. 2014 Aug 1. 14 (8):1581-7. [QxMD MEDLINE Link].
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 (Phila Pa 1976). 2008 Jan 1. 33 (1):E21-4. [QxMD MEDLINE Link].
Scoles PV, Latimer BM, DigIovanni BF, Vargo E, Bauza S, Jellema LM. Vertebral alterations in Scheuermann's kyphosis. Spine (Phila Pa 1976). 1991 May. 16 (5):509-15. [QxMD MEDLINE Link].
Bradford DS, Moe JH, Montalvo FJ, Winter RB. Scheuermann's kyphosis and roundback deformity. Results of Milwaukee brace treatment. J Bone Joint Surg Am. 1974 Jun. 56 (4):740-58. [QxMD MEDLINE Link].
Bradford DS, Moe JH, Montalvo FJ, Winter RB. Scheuermann's kyphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients. J Bone Joint Surg Am. 1975 Jun. 57 (4):439-48. [QxMD MEDLINE Link].
Murray PM, Weinstein SL, Spratt KF. The natural history and long-term follow-up of Scheuermann kyphosis. J Bone Joint Surg Am. 1993 Feb. 75 (2):236-48. [QxMD MEDLINE Link].
Sachs B, Bradford D, Winter R, Lonstein J, Moe J, Willson S. Scheuermann kyphosis. Follow-up of Milwaukee-brace treatment. J Bone Joint Surg Am. 1987 Jan. 69 (1):50-7. [QxMD MEDLINE Link].
Graat HC, Schimmel JJ, Hoogendoorn RJ, van Hessem L, Hosman A, de Kleuver M. Poor Radiological and Good Functional Long-term Outcome of Surgically Treated Scheuermann Patients. Spine (Phila Pa 1976). 2016 Jul 15. 41 (14):E869-78. [QxMD MEDLINE Link].
Lonstein JE, Winter RB, Moe JH, Bradford DS, Chou SN, Pinto WC. Neurologic deficits secondary to spinal deformity. A review of the literature and report of 43 cases. Spine (Phila Pa 1976). 1980 Jul-Aug. 5 (4):331-55. [QxMD MEDLINE Link].
Ryan MD, Taylor TK. Acute spinal cord compression in Scheuermann's disease. J Bone Joint Surg Br. 1982. 64 (4):409-12. [QxMD MEDLINE Link].
Wood KB, Melikian R, Villamil F. Adult Scheuermann kyphosis: evaluation, management, and new developments. J Am Acad Orthop Surg. 2012 Feb. 20 (2):113-21. [QxMD MEDLINE Link].
Fon GT, Pitt MJ, Thies AC Jr. Thoracic kyphosis: range in normal subjects. AJR Am J Roentgenol. 1980 May. 134 (5):979-83. [QxMD MEDLINE Link].
Shelton YA. Scoliosis and kyphosis in adolescents: diagnosis and management. Adolesc Med State Art Rev. 2007 May. 18 (1):121-39, x. [QxMD MEDLINE Link].
Tsirikos AI. Scheuermann's Kyphosis: an update. J Surg Orthop Adv. 2009 Fall. 18 (3):122-8. [QxMD MEDLINE Link].
Kaiser R, Behrbalk E, Walsh M, Waldauf P, Perez Romera AB, Mehdian H. Can MRI Predict Flexibility in Scheuermann Kyphosis Patients?. Clin Spine Surg. 2017 Aug. 30 (7):E938-E941. [QxMD MEDLINE Link].
Lowe TG. Scheuermann disease. J Bone Joint Surg Am. 1990 Jul. 72 (6):940-5. [QxMD MEDLINE Link].
Tsirikos AI, Jain AK. Scheuermann's kyphosis; current controversies. J Bone Joint Surg Br. 2011 Jul. 93 (7):857-64. [QxMD MEDLINE Link].
de Mauroy J, Weiss H, Aulisa A, Aulisa L, Brox J, Durmala J, et al. 7th SOSORT consensus paper: conservative treatment of idiopathic & Scheuermann's kyphosis. Scoliosis. 2010 May 30. 5:9. [QxMD MEDLINE Link].
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. 2009 Dec. 45 (4):595-603. [QxMD MEDLINE Link].
Montgomery SP, Erwin WE. Scheuermann's kyphosis--long-term results of Milwaukee braces treatment. Spine (Phila Pa 1976). 1981 Jan-Feb. 6 (1):5-8. [QxMD MEDLINE Link].
Riouallon G, Morin C, Charles YP, Roussouly P, Kreichati G, Obeid I, et al. Posterior-only versus combined anterior/posterior fusion in Scheuermann disease: a large retrospective study. Eur Spine J. 2018 Sep. 27 (9):2322-2330. [QxMD MEDLINE Link].
Kostuik JP. Anterior Kostuik-Harrington distraction systems. Orthopedics. 1988 Oct. 11 (10):1379-91. [QxMD MEDLINE Link].
Horn SR, Poorman GW, Tishelman JC, Bortz CA, Segreto FA, Moon JY, et al. Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012. Spine Deform. 2019 Jan. 7 (1):100-106. [QxMD MEDLINE Link].
Lee CH, Won YI, San Ko Y, Yang SH, Kim CH, Park SB, et al. Posterior-only versus combined anterior-posterior fusion in Scheuermann disease: a systematic review and meta-analysis. J Neurosurg Spine. 2020 Dec 25. 1-9. [QxMD MEDLINE Link].
Yanik HS, Ketenci IE, Coskun T, Ulusoy A, Erdem S. Selection of distal fusion level in posterior instrumentation and fusion of Scheuermann kyphosis: is fusion to sagittal stable vertebra necessary?. Eur Spine J. 2016 Feb. 25 (2):583-9. [QxMD MEDLINE Link].
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 (Phila Pa 1976). 1994 Aug 1. 19 (15):1680-5. [QxMD MEDLINE Link].
Arlet V, Schlenzka D. Scheuermann's kyphosis: surgical management. Eur Spine J. 2005 Nov. 14 (9):817-27. [QxMD MEDLINE Link].
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 (Phila Pa 1976). 2006 Sep 15. 31 (20):2316-21. [QxMD MEDLINE Link].
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. 2007 Dec. 20 (8):586-93. [QxMD MEDLINE Link].
Lowe TG. Double L-rod instrumentation in the treatment of severe kyphosis secondary to Scheuermann's disease. Spine (Phila Pa 1976). 1987 May. 12 (4):336-41. [QxMD MEDLINE Link].
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). 2009 Sep 15. 34 (20):E729-34. [QxMD MEDLINE Link].
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). 2009 Feb 15. 34 (4):E149-52. [QxMD MEDLINE Link].
Lonner BS, Toombs CS, Guss M, Braaksma B, Shah SA, Samdani A, et al. Complications in operative Scheuermann kyphosis: do the pitfalls differ from operative adolescent idiopathic scoliosis?. Spine (Phila Pa 1976). 2015 Mar 1. 40 (5):305-11. [QxMD MEDLINE Link].

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 Former 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, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Nothing to disclose.

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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