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. 2022 Dec 7;7(11):782-791.
doi: 10.1530/EOR-22-0063.

Scheuermann's kyphosis: update on pathophysiology and surgical treatment

Amer Sebaaly  1   2 , Sarah Farjallah  2 , Khalil Kharrat  2 , Gaby Kreichati  1   2 , Mohammad Daher  1
Affiliations

Scheuermann's kyphosis: update on pathophysiology and surgical treatment

Amer Sebaaly et al. EFORT Open Rev. .

Abstract

Scheuermann's Kyphosis (SK) is a rigid spinal kyphosis. Several theories have been proposed concerning its pathogenesis, but it is, to this day, still unknown. It has a prevalence of 0.4-8.3% in the population with a higher incidence in females. Clinical examination with x-rays is needed to differentiate and confirm this diagnosis. Non-surgical management is reserved for smaller deformities and in skeletally immature patients, whereas surgery is recommended for higher deformities. Combined anterior and posterior approach was considered the gold standard for the surgical treatment of this disease, but there is an increasing trend toward posterior-only approaches especially with use of segmental fixation. This study reviews the pathophysiology of SK while proposing a treatment algorithm for its management.

Keywords: fusion levels; scheuermann’s kyphosis; surgical management; treatment algorithm.

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Figures

Figure 1
Figure 1
Clinical presentation of a 15-year-old boy with SK. Note the ‘goose-neck deformity’ and the angular kyphosis with Adam’s forward bending test.
Figure 2
Figure 2
Full spine lateral x-ays showing a typical thoracic SK (A) and a lumbosacral SK (B). Note in the two cases that the C7 plumbline is behind the posterior sacral edge.
Figure 3
Figure 3
Typical wedging in three consecutive vertebras.
Figure 4
Figure 4
Non Scheuermann Kyphosis. The thoracic kyphosis is harmonious and there is no wedging of the apical vertebras.
Figure 5
Figure 5
Case of a 15-year-old male who presented with a 100° kyphosis (A). A fulcrum test showed that the most horizontal disc is L3-L4 (B). He was operated with multilevel Ponte osteotomies (C). The postoperative x-ray showed a thoracic kyphosis of 50°.
Figure 6
Figure 6
Proximal junctional failure (A) with proximal hooks pullout. (B) Distal junctional failure with screw pullout.
Figure 7
Figure 7
Proposed treatment algorithm.
See this image and copyright information in PMC

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