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Kyphosis and Scheuermann's Disease

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Kyphosis is a spinal condition characterized by an excessive forward curvature of the spine. Scheuermann's Disease, sometimes called 'Scheuermann's Kyphosis' (Figure 1)is a type of kyphosis that occurs in adolescents. Kyphosis may cause a deformity such as a humpback or hunchback or give patients a pitched-forward appearance. Abnormal kyphosis is more commonly found in the thoracic or thoracolumbar (chest area/middle back), and frequently causes the neck to protrude forward as well. Kyphosis is best seen with the patient forward with the knees straight.

clinical photos of a patient with Scheuermann's Kyphosis
Figure 1. Clinical photographs of a patient with Scheuermann's Kyphosis.

SpineUniverse talked to Dr. Thomas Lowe, an Orthopaedic Surgeon and spine specialist in Colorado about these conditions.

SpU: Dr. Lowe, if the spine is supposed to have natural curves, why is kyphosis a problem?

Dr. Lowe: It's correct that the spine does have natural curves. It's what gives the spine its ability to be flexible and to support the weight and movement of the entire body. However, too much of an outward curve, especially in the upper spine, can be problematic because it causes the body to become pitched forward. The spine may no longer be able to adequately support the body, it can lose its flexibility, and it often causes the chest, lungs, and heart to become too crowded. This is why people with severe kyphosis can develop breathing and heart problems as well as back pain as adults.

SpU: Why don't people with kyphosis just stand up straighter and correct the curve themselves?

Dr. Lowe: Some people can -- when the kyphosis is due to poor posture. Patients with postural kyphosis are prescribed physical therapy to help them correct their posture usually through strengthening and stretching exercises. However, if the kyphosis is caused by a problem with the structural components of the spine, such as with Scheuermann's disease, patients cannot fix the problem themselves. For these patients, bracing is often needed and frequently successful in correcting the deformity in adolescents who are still growing. In some cases, where growth is complete and a severe deformity has occurred, surgery is necessary to straighten and stabilize the spine.

SpU: Dr. Lowe, you mention Scheuermann's disease. What is that and how is it similar to kyphosis?

Dr. Lowe: Scheuermann's disease is a type of kyphosis that occurs when healthy, rectangular shaped vertebrae become wedge shaped. The exact causes of Scheuermann's disease are still unknown, however researchers believe it has something to do with an abnormality in how vertebrae develop and grow. Symptoms of Scheuermann's disease are similar to other types of kyphosis and may include one or more of the following:

• Severe back pain with sports and other activities
• A rigid curve of the spine that gets worse when bending and only partially corrects itself when standing
• Difficulty standing erect (Figure 2)
• Chest pain or difficulty breathing caused by decreased lung capacity
• Tight hamstring muscles in the legs
• Forward posture of the head and neck

X-ray demonstrating abnormal spinal curvature, Scheuermann's Kyphosis
Figure 2. Side (lateral) X-ray demonstrates Scheuermann's Kyphosis.
Updated on: 09/07/12
Baron S. Lonner, MD
Dr. Lowe's answers to commonly asked questions about kyphosis and Scheuermann's disease are quite helpful. Of note, many patients with kyphosis have no back pain or significant noticeable deformity. When the kyphosis is under 90 degrees or so, there is little risk to lung function. However, there are some patients, even with curvature of 70 degrees or less, who may have marked deformity and/or pain. Each case is individual and must be treated so.
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