Scheuermann's Kyphosis - Causes, Diagnosis, and Treatment

Introduction

The ailment of Scheuermann's kyphosis affects the upper back. It gives the upper back a rounded contour, making one appear slumped over. Scheuermann's disease is another name for it. Curves should be present in a normal, healthy spine. These curves should be visible when viewed from the side. Too much thoracic spine (mid-back) curvature, on the other hand, can be harmful. Kyphosis is the medical term for this condition.

Scheuermann's disease refers to a specific type of Scheuermann's kyphosis. It was first found in the early 1920s by a Danish radiologist, and it is named after him. Scheuermann's kyphosis is characterized by a wedge-like form of the vertebrae. The thoracic spine curves forward at a larger angle as a result. During phases of bone growth, Scheuermann's kyphosis develops.

When the front region of the spine does not grow as swiftly as the back, the problem occurs.

The healthy, rectangular-shaped vertebrae become triangular-shaped and squeezed together as a result of this. As a result, the thoracic spine curves more than normal. Patients are prone to stooping forward and bending over.

How Does the Normal Spine Appear?

The spinal column extends from the top of the skull to the bottom of the pelvis. There are 33 vertebrae in the column, each with a cartilaginous disk between them. These absorb and disperse the force of the impact. They also prevent the vertebrae from scraping against one another while moving. The vertebrae of a healthy person are rectangular in shape and layered, one on top of the other.

How to Identify a Case of Scheuermann’s Kyphosis?

The following are the main symptoms of Scheuermann's kyphosis:

• Back that is rounded and hunched.

• It is often difficult to notice the rounding, while other times, it is more obvious.

• When standing erect, children's bent backs are unable to straighten.

• Backache.

• Back pain affects about half of children with Scheuermann's kyphosis.

• During the growth surge that occurs around adolescence, the indications of kyphosis are commonly visible.

• A stiff spine curve that worsens when bending forward and only partially corrects itself after standing.

• Scoliosis with coexisting scoliosis.

• Chest pain or trouble breathing due to a reduction in lung capacity; only in exceptional cases.

What Causes Scheuermann's Kyphosis?

The bones constituting the spine (called vertebrae) are usually rectangular. With flexible cartilage in between, they stack like bricks. When a child develops Scheuermann's disease, the front edges of some upper back vertebrae grow more slowly than the back edges.

These vertebrae become wedge-shaped, and the spine curves as the vertebrae stack up, making the background out.

Doctors are not sure why certain children get Scheuermann's kyphosis, but it runs in families.

The symptoms usually appear during or shortly after the puberty growth spurt. When children are diagnosed, they are usually between the ages of 12 and 15.

How Is Scheuermann's Kyphosis Diagnosed?

Before making a definitive diagnosis, the doctor will conduct a medical history to rule out other disorders with similar symptoms. There will also be a physical examination, which may involve the following:

• Adam's Forward Bending Test: The patient is instructed to bend forward at the waist. This could indicate thoracolumbar kyphosis. Palpation, often known as a hands-on examination, is a technique for detecting spinal abnormalities through touch. The thoracic portion of the spine is abnormally bent from the side when Scheuermann's illness is present.

• Range of Motion: The doctor evaluates the patient's ability to bend forward, backward, and side to side.

• X-Rays: X-rays of the spine will be required to provide a clear diagnosis. AP (anterior/posterior) X-rays of the spinal column are taken at full length. The patient stands with his arms stretched forward and his head held high. While the patient is lying down, X-rays may be performed to determine curve flexibility and spinal wedging.

The kyphosis curvature is measured in degrees. A curvature that has no anomalies in the vertebrae (and that goes away quickly when the patient lies down) is usually classified as postural. Scheuermann's disease, on the other hand, is diagnosed when a patient has a kyphotic curve of at least 50 degrees. At least 5 degrees of the wedge between three or more neighboring vertebrae per segment (15 degrees total across three segments). Schmorl's nodes are small disc herniations that occur through the endplates of the vertebrae.

How Is Scheuermann's Kyphosis Treated?

Patients with Scheuermann's kyphosis will see an orthopedist (a doctor who treats conditions involving the bones). The orthopedist will examine the spine and X-rays before making a therapy recommendation. There are several treatment options available, including:

• Kyphosis may not require treatment if the rounding of the back is not expected to cause any complications.

• Routine checks will be performed on the children to ensure that the rounding does not become an issue.

• When children have reached the end of their growth, most cases will come to a halt.

• Bracing the back.

• A brace may be recommended by the doctor.

• It is similar to a jacket that one can wear under clothes.

• It will not correct the curve, but it will prevent it from worsening.

• Physical therapy is a type of treatment that involves to maintain the flexibility of the back.

• Strengthening exercises of the back and core muscles to better support the spine might occasionally help.

• Surgery.

• Surgical intervention is rarely required.

• In severe cases of discomfort or breathing problems, doctors may propose a technique called spinal fusion.

• Indications for nonoperative stretching, monitoring, and physical treatment.

• Most patients with kyphosis less than 60 degrees and asymptomatic (minor symptoms) belong to this category and can be treated with observation alone.

• For individuals with spondylolysis, physical treatment, posture improvement activities, back extensor strengthening core muscle strengthening have little benefit.

• Indications for bracing with an extension-type orthosis (Jewitt type - with high chest pad).

• In individuals with growth remaining, kyphosis 60°to 80° is most beneficial.

• Patient compliance is frequently a problem.

• In curves, less than 65 degrees, a correction of more than 15 degrees in the brace normally does not result in correction, but it can halt progression.

• Indications for posterior spinal fusion, osteotomy, and anterior release surgery.

• Kyphosis > 75 degrees kyphosis > 75 degrees kyphosis > 75 degrees kyphosis > 75 degrees kyphosis > 75 degrees kyphosis.

• Studies demonstrate that surgery improves pain by 60 to 90 percent (with no association with the amount of correction) and that residual curves greater than 75 degrees correspond to lower functional outcomes.

• PSF with dual rod instrumentation +/- anterior release and interbody fusion method PSF with dual rod instrumentation +/- anterior release and interbody fusion approach

• Thoracic spine to the posterior midline.

• The current consensus is to incorporate the complete kyphotic Cobb angle and then stop distally at the first stable sagittal vertebra (first vertebra bisected by the posterior sacral vertical line).

• Previously, the distal lordotic disk was stopped, but there was a significant prevalence of distal junctional kyphosis.

• Pedicle screws and hooks are commonly used.

• Intracanal hooks can be harmful near the apex of a curve because they can compress the spinal cord.

• It is not always necessary to instrument at the peak.

• Procedure for rectification.

• Two rods are normally inserted in top anchors and then carried down to bottom pedicle screws to create a cantilever.

• The posterior anchors are compressed.

Conclusion

Scheuermann’s kyphosis is a congenital condition and is completely treatable with both surgical and nonsurgical means. However, early diagnosis and prompt treatment are vital in this aspect.