Scheuermann Kyphosis Workup

Updated: Feb 15, 2019
  • Author: Clifford Tribus, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Workup

Laboratory Studies

At present, no genetic markers or laboratory studies exist to assist the physician in confirming the diagnosis of Scheuermann kyphosis (Scheuermann disease). If treatment is rendered, the appropriate laboratory studies should be ordered. 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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Radiography

A standard radiographic evaluation of a patient with Scheuermann kyphosis 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 permit an accurate evaluation of sagittal balance.

The diagnosis of Scheuermann kyphosis is confirmed on the lateral radiographs. (See the image below.) The angle between the endplates of each respective vertebral body should be measured with the Cobb technique. Three adjacent vertebral bodies with 5° of anterior wedging confirm the diagnosis of Scheuermann kyphosis.

Preoperative lateral radiograph of patient with 85 Preoperative lateral radiograph of patient with 85° thoracic deformity secondary to 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; 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; this can affect the ability to achieve correction with bracing and surgical intervention.

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MRI, CT, and CT Myelography

Magnetic resonance imaging (MRI), computed tomography (CT), and CT myelography can be helpful adjunctive studies in planning the care of a patient with Scheuermann kyphosis. In particular, MRI helps the surgeon further define the local anatomy; it may also prove useful for flexibility assessment, thereby potentially reducing the patient's exposure to radiation. [25]  Special attention should be paid 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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