• Clinical science

Scheuermann juvenile kyphosis

Summary

Scheuermann kyphosis is a growth-related disorder of the thoracic spine that leads to hyperkyphosis. The condition is typically diagnosed in early adolescence following a referral to the physician because of poor posture or a spinal deformity discovered in a school screening program. Subacute back pain is present in some cases. Conventional lateral spine x-rays showing > 40° of kyphosis (normal: 20–40°) and anterior vertebral wedging of > 5° of three or more adjacent vertebrae confirm the diagnosis. First-line therapy includes physical therapy and NSAIDs for pain. Bracing is used for patients with kyphosis greater than 60°, while those with kyphosis greater than 75° or neurological deficits may have to undergo spinal fusion to relieve symptoms. Although symptoms typically resolve when patients reach skeletal maturity, there may be complications such as chronic pain, permanent deformity, degenerative disc disease, spondylolysis, and spondylolisthesis in adulthood.

Epidemiology

  • Sex: >
    • Taller boys are at increased risk of severe disease.
  • Peak incidence: 13–16 years [1]
  • Prevalence: 1–8% in the US
  • Location: thoracic spine > lumbar spine

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • Etiology unclear
  • Risk factors
    • Hereditary predisposition [2][3][4]
    • Increased height and weight in adolescence; rapid longitudinal growth [5]
    • Participation in competitive sports involving frequent flexion and extension of the trunk [6]

Clinical features

  • Visible spinal deformity
    • Rigid hyperkyphosis of the thoracic spine (rounded appearance of the upper back)
    • Compensatory lumbar and/or cervical hyperlordosis
  • Back pain
    • Location: thoracic and/or lumbar spine
    • Onset: subacute
    • Exacerbating/alleviating factors: worse after activity; improves with rest

Diagnostics

  • Physical examination revealing the characteristic spinal deformity and a possible history of back pain
  • Lateral x-ray of the spine

Treatment

  • Physical therapy: to strengthen and stretch back muscles [9]
  • NSAIDS: to treat back pain
  • Bracing or casting: if kyphosis is > 60° [10]
  • Surgery (spinal fusion) is performed rarely and only in severe cases with the following features:
    • Kyphosis greater than 75° [11]
    • Persistent severe back pain
    • Neurological complications (e.g., cord compression)

Complications

We list the most important complications. The selection is not exhaustive.

Prognosis

  • In the majority of patients, progression of the deformity halts and few symptoms persist once skeletal development is complete.
  • Those with severe kyphosis (> 75°) can continue to have back pain and progression of the deformity. [8]
  • 1. Nowak, JE. Scheuermann Disease. In: Talavera F, Andary MT, Kishner S. Scheuermann Disease. New York, NY: WebMD. https://emedicine.medscape.com/article/311959. Updated October 19, 2018. Accessed February 15, 2019.
  • 2. Damborg F, Engell V, Andersen M, et al. Prevalence, Concordance, and Heritability of Scheuermann Kyphosis Based on a Study of Twins. J Bone Joint Surg Am. 2006; 88(10): pp. 2133–2136. doi: 10.2106/jbjs.e.01302.
  • 3. Zaidman AM, Zaidman MN, Strokova EL, et al. The Mode of Inheritance of Scheuermann’s Disease. Biomed Res Int. 2013; 2013: pp. 1–9. doi: 10.1155/2013/973716.
  • 4. Palazzo C, Sailhan F, Revel M. Scheuermann's disease: An update. Joint Bone Spine. 2014; 81(3): pp. 209–214. doi: 10.1016/j.jbspin.2013.11.012.
  • 5. Fotiadis E, Kenanidis E, Samoladas E, et al. Scheuermann’s disease: focus on weight and height role. Eur Spine J. 2008; 17(5): pp. 673–678. doi: 10.1007/s00586-008-0641-x.
  • 6. Frontera W. Medical Management and Rehabilitation. In: Micheli L, Herring S, Silver J, eds. Clinical Sports Medicine. Elsevier Health Sciences; 2007.
  • 7. Kado DM. Overview of hyperkyphosis in older persons. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-hyperkyphosis-in-older-persons. Last updated February 4, 2019. Accessed February 18, 2019.
  • 8. Mansfield JT, Bennett M. Scheuermann Disease. StatPearls. 2018. pmid: 29763141.
  • 9. de Mauroy JC, Weiss HR, Aulisa AG, et al. 7th SOSORT consensus paper: conservative treatment of idiopathic & Scheuermann's kyphosis. Scoliosis. 2010; 5(1). doi: 10.1186/1748-7161-5-9.
  • 10. Nigrovic PA. Back pain in children and adolescents: Causes. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/back-pain-in-children-and-adolescents-causes. Last updated August 27, 2018. Accessed February 18, 2019.
  • 11. Kliegman R, Stanton B, St. Geme J, Schor N. Nelson Textbook of Pediatrics. Elsevier; 2015.
  • 12. Lorente A, Barrios C, Lorente R, et al. Severe hyperkyphosis reduces the aerobic capacity and maximal exercise tolerance in patients with Scheuermann disease. The Spine Journal. 2019; 19(2): pp. 330–338. doi: 10.1016/j.spinee.2018.07.002.
  • 13. Tribus C. Scheuermann Kyphosis. In: Talavera F, Shaffer W, Goldstein J. Scheuermann Kyphosis. New York, NY: WebMD. https://emedicine.medscape.com/article/1266349. Updated February 15, 2019. Accessed February 18, 2019.
last updated 02/20/2019
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