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Treatment of 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' 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.

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

SpU: Can kyphosis be prevented?

Dr. Lowe: Structural kyphosis - the type caused by an abnormality in the structures of the spine, such as Scheuermann's disease - cannot be prevented. However, in many cases it can be corrected through bracing and, as I mentioned earlier, surgery. Postural kyphosis is something that can be corrected by using good body mechanics and a back exercise program.

Body mechanics refers to how well we keep our body in balance and avoid excessive stress on our spines. Many people get so used to bad posture (slouched shoulders, head down, knees bent); they don't even know they are doing it until they start having back pain. Here's what good posture looks like when you are standing:

• Feet slightly apart
• Knees straight
• Chin slightly tucked in
• Shoulders back

Having good posture may not protect you from ever having back pain, but it plays an important role in keeping your spine (and the rest of your body) healthy.

SpU: Is the treatment for kyphosis different from Scheuermann's disease?

Dr. Lowe: The treatment plans are similar but differ depending on the patient's age, curve magnitude, and coexisting medical and neurological problems. Fortunately, neurological difficulties are rare. In the case of Scheuermann's disease, early intervention is most important. Non-surgical treatments may include annual observation, bracing (Figure 3), and physical therapy. Patients with postural kyphosis are often encouraged to participate in a physical therapy program that includes posture training and exercise to strengthen the spinal muscles.

Typical brace used to treat Scheuermann's Kyphosis
Figure 3. An example of brace treatment.

SpU: Are these conditions treated surgically?

Dr. Lowe: Yes - there are instances when a patient with kyphosis or Scheuermann's disease requires surgery. Surgery may be indicated if the curve is severe and progressive, neurological symptoms exist, and pain cannot be adequately resolved non-operatively (e.g. physical therapy, back exercises). The surgery always includes spinal instrumentation and fusion to correct the deformity and permanently stabilize the spine.

Pre-op and post-op x-rays and photographs
Figure 4. (Left) Patient before surgery with pre-operative x-ray. (Right) Same patient after surgery.

SpU: Thank you Dr. Lowe for answering our questions about kyphosis and Scheuermann's Disease.

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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Kyphosis and Scheuermann's Disease

Scheuermann's disease is a type of kyphosis that occurs when healthy vertebral become wedge shaped.
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