Scheuermann's kyphosis

Question 1

What is Scheuermann’s kyphosis defined as?

Answer 1

• A RIGID THORACIC HYPERKYPHOSIS OF > 45 degrees

Question 2

What is the kyphosis caused by?

Answer 2

• Anterior wedging of >5 degrees across 3 consecutive vertebra

Question 3

How is it differentiated from postural kyphosis?

Answer 3

• Rigidity of the spine

Question 4

What is its epidemiology?

Answer 4

• 1-8%
• Most Common type of STRUCTURAL KYPHOSIS in ADOLESCENTS
• M 2:1 F
• location
  
  • Thoracic spine
  • less common forms occurs in thoracolumbar/lumbar region

Question 5

What is it pathology? What is its inheritance pattern ?

Answer 5

• Exactly unknown
• AUTOSOMAL DOMINANT

Question 6

What are the associated condition?

Answer 6

• HYPERLORDOSIS
• SPONDYLOLYSIS 30-50%
• SCIOLOSIS 3%

Question 7

What is its prognosis?

Answer 7

• Back pain in adults that very rarely limits ADLs ( mild curve mean 71^o
• Curves >75 degrees are likely to cause severe thoracic pain

Question 8

what is the classification of scheuermann’s kyphosis?

Answer 8

• Thoracic Scheuermann’s kyphosis
  
  • most common form
• Thoracolumbar Scheuermann’s kyphosis
  
  • less common
  • assoc w increased back pain
  • more irregular end-plates noted on xray
  • no vertebral wedging involved

Question 9

what is the pt main complaint?

Answer 9

• thoracic/ lumbar
  
  • pain
  • cosmesis

Question 10

what do you find on examination?

Answer 10

• Thoracic kyphosis that does not correct with HYPEREXTENSION-
• forward flexion- sharp bend in spine cf postural which is smooth, symmetrical see pic
• normal thoracic kyphosis is 20-40 degrees
• compensatory hyperlordosis cervical /lumbar spine
• tight hamstrings

Question 11

what are the classic X-ray findings?

Answer 11

• Anterior wedging across 3 consecutive vertebra
• disc narrowing
• endplate irregularities
• SCHMORL’s NODES- HERNIATION OF DISC into VERTEBRAL ENDPLATE
• Scoliosis compensatory hyperlordosis look for spondylolsis on lumbar films
• hyperextension lateral xray film- scheuermann’s kyphosis remains inflexible

Question 12

What is the use of MRI in this condition ?

Answer 12

• Determines any disc hernitation, epidural cysts, spinal stenosis
• show vertebral wedging, dehydrate disc, Schmorl’s nodes- see mri scan

Question 13

What does tx involve ?

Answer 13

Non operative

• Observe
  
  • KYPHOSIS <60 degrees & asymptomatic
  • most fall into this group
• Bracing with extension type orthosis
  
  • ​CTLSO modified Milwalkee- see pic
  • Kyphosis 60-80^o in pt Reisser 3 or less
  • with poor pt compliance
  • stop progression not lead to correction

Surgery

• POSTERIOR SPINAL FUSION W DUAL ROD INSTRUMENTATION+/- ANT RELEASE AND INTERBODY FUSION
  
  • for Kyphosis >75⁰ rigid, in skeletal mature pt
  • Neuro deficit/ spinal cord compression
  • severe pain in adults
• • use of pedicle screw post are often sufficient and use of ant procedure is reducing

Question 14

What are the outcomes of surgery?

Answer 14

• 60-90% reduction in pain with surgery
• no correlation with amount of correction

Question 15

describe the surgical technique?

Answer 15

• PSF w DUAL rod instrumentation
• Post midline to thoracic spine
• Arthrodesis- include entire kyphotic cobb angle and stop distally to include 1st lordotic disc.
• posterior bone grafting form iliac crest recommended to enhance fusion
• Fixation - combo of hooks and pedicle screws
  
  • hooks maybe dangerous at apex of curve as potentially compress spinal cord
• Correcting technique
  
  • insitu bending
  • goal to obtain final kyphosis of 45-50 degrees

Anterior release and interbody fusion- thorascopic anterior discectomy and interbody fusion have decreased morbidity of thoracotomy

Question 16

What are the complications ?

Answer 16

• Neurological
  
  • higher than idiopathic scoliosis corrective surgeries
  • must monitor motor and sensory evoked potentials
• Junctional kyphosis
  
  • occurs in 20-30% pts
  • avoid by making proper selection of fusion levels
  • avoid overcorrection - shouldn’t exceed 50% original curve