Scheuermann's Kyphosis: When Surgery is Needed

Question: I am a 25-year-old Australian male with moderate Scheuermann's kyphosis. I have seen many specialists to help cope with the condition, and I make sure to stay fit and strong, but it still has had a significant impact on my life—most notably putting an end to my career as a professional pianist.
Doctor or Nurse using a tabletI want more than anything to have a straighter, more flexible and pain-free back. I thought this was just a dream until I read the articles about surgery on SpineUniverse. Those patients look SO much better post-surgery. My question is, is it too late at age 25 to consider this? Is there an improvement in flexibility as well as posture?
—DeFuniak Springs, FL

Answer: Surgery for Scheuermann's kyphosis at age 25 is not typically warranted because your spine has completed its growth. However, without knowing the degree of your curvature, this cannot completely be ruled out. You probably read in the articles a lot of talk about adolescents; literature on Scheuermann's kyphosis focuses on that age range because that's when the condition is usually first diagnosed and treatment is implemented to avoid progression.

Quick facts on Scheuermann's kyphosis (for those who don't know much about it):

  • It's a type of primary kyphosis, meaning that it isn't caused by another medical condition.
  • It's a structural problem with the spine that creates wedge-shaped vertebrae. The back of the vertebrae (posterior) grow at a normal pace, but the front of the vertebrae (anterior) grow more slowly. Normal vertebrae are somewhat rectangular and work like building blocks: they stack one on top of the other. Wedged vertebrae can cause the spine to curve too much because the vertebrae don't stack as well.
  • It's usually diagnosed during growth spurts, so that's why it's commonly diagnosed during adolescence.
  • Scheuermann's kyphosis affects the thoracic spine (upper back).
  • The thoracic spine is supposed to curve some; spinal curves are part of what make the spine so efficient at distributing the body's weight and adapting to movements. A normal thoracic curve is 20º-40º.
  • Scheuermann's kyphosis is diagnosed if the thoracic spine curves more than 50º, there are at least three consecutive wedged vertebrae (each wedged by at least 5º), and there are small disc herniations called Schmorl's nodes.

It's good to hear that you've been under a doctor's care for many years, and I assume that he or she has been monitoring your curve. You write that your Scheuermann's kyphosis is moderate, which is also good to hear.

Surgery generally isn't done for moderate cases, but I don't know the details of your particular curve. Your age doesn't necessarily preclude you from surgery, but your curve severity might not warrant surgery. I know that you want to have a straight spine, but spine surgery is a serious undertaking, and doctors do not recommend it unless it's absolutely necessary.

Typically, surgery is recommended for severe cases—at least 70º. Neurological complications (weakness, tingling, difficult moving, e.g.) also factor into whether or not surgery is recommended. For more information on the type of surgery done, you can read this article.

For patients who have surgery for Scheuermann's kyphosis, they do usually see posture improvement. However, flexibility improvement isn't as likely because the thoracic spine isn't very flexible to begin with. (It's not very flexible to various reasons, including that the ribs are attached to it, which limits movement. The shape of the spinous process in the thoracic spine also limits flexibility. You can learn more about the thoracic spine in the article Anatomy of the Upper Back.)

In conclusion, I'd say check in again with your spine specialist to make sure that your curve isn't getting worse. You should stay focused on keeping fit, and you should also be doing back strengthening exercises to keep your spine strong and as healthy as possible. Your doctor should be able to recommend a good physical therapist, if he or she hasn't done so already. The PT can develop a back strengthening program just for you.