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Scheuermann’s Kyphosis
Scheuermann’s kyphosis, also known as Scheuermann’s disease, refers to a curvature in the thoracic spine that develops in adolescence. The thoracic spine is the segment of the spine extending from your shoulders to your waist. Hyperkyphosis refers to an excessive kyphotic curvature of the thoracic spine. As a result of excessive kyphosis, patients have a stooped forward or bent-over posture, and a hunchback. This disorder is more common among boys.
Scheuermann’s kyphosis is a primary kyphosis as it is a separate entity and does not result from another condition; postural kyphosis usually develops due to a poor posture while Scheuermann’s disease is a structural kyphosis caused by a structural deformity of the spine. Patients with postural kyphosis can usually correct the deformity by improving the posture but structural kyphosis cannot be corrected by rectifying the posture. Sometimes, a patient with structural kyphosis demonstrates a sharp angular gibbus deformity.
Causes
The exact cause of Scheuermann’s kyphosis is not known, however it is thought to be due to wedging of the vertebral bodies, which result in the abnormal curvature of the spine. Scheuermann’s kyphosis appears to run in families. Growth of Schmorl’s nodes and the protrusion of the disc cartilage into the vertebral end plates may affect the contour of the spine.
Symptoms
Patients with kyphosis may develop back ache, stiffness of the back, tenderness, a physical deformity of the spine (hunchback), and fatigue. In severe cases, patients may also experience a difficulty in breathing as a result of pressure over the lungs.
Diagnosis
Your doctor will take a brief history, comprising of your family history, history of your present symptoms, and your past medical history. Then, a physical and neurological examination is conducted to assess your reflexes, muscle strength and sensations in order to arrive at an accurate diagnosis. During physical examination, your doctor will evaluate cardiopulmonary (heart and lung) function and range of motion of the spine. Your doctor may palpate (feel) the spine for abnormalities. Your doctor may perform an Adam’s forward bending test, in which you are asked to bend forward at the waist and the doctor will check for the symmetry of the hips and shoulders, ribs or any other prominence. Plain X-rays of the spine often show the wedging of the vertebral body, Schmorl’s nodes and abnormalities in the vertebral end plates. The MRI or CT scans can help determine nerve and spinal cord compression.
The diagnosis of Scheuermann’s kyphosis may be suspected based on the presence of wedge-shaped vertebral bodies, Schmorl’s nodes, and a kyphotic curve measuring 50 degrees or more.
Treatment
Treatment of Scheuermann’s disease may vary depending on the degree of the curve, patient’s age, progression of the curve, and rarely neurological dysfunction. Treatment options include:
- A period of observation to monitor any changes in the abnormal curvature
- Spinal bracing is usually indicated to slow the progression of scoliosis
- Physical therapy can be helpful in improving your flexibility, strength, and range of motion of the spine
- Regular exercise can help decrease your risk of cardiovascular diseases
Spine surgery may be an option for patients with severe kyphosis (more than 70 degrees), those with co-existent neurological problems, or severe pain that is not relieved by conservative treatment.
Surgical treatment options for Scheuermann’s kyphosis include spinal fusion (bone grafts) and instrumentation (screws and rods). The aim of the surgery is to rectify the curve, halt the progression of the curve, treat the deformity, and stabilize the spine. Your surgeon will discuss the surgical options as well as the potential risks and benefits with you. Following the surgery, you may be required to wear a back brace to support the spine during the healing process. During the post-operative period, X-rays are taken at regular intervals to monitor the fusion process.
Contact your doctor for any queries regarding Scheuermann’s kyphosis. Your doctor is your best source of information to answer all your questions and help you understand the condition better.
