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Scheuermann's Kyphosis

Diagnosis, Management, and Selecting Fusion Levels

Sardar, Zeeshan M., MD, MSc; Ames, Robert J., MD; Lenke, Lawrence, MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 15, 2019 - Volume 27 - Issue 10 - p e462–e472
doi: 10.5435/JAAOS-D-17-00748
Review Article

Scheuermann's kyphosis (SK) is a rigid structural deformity of the thoracic spine defined radiographically as three or more contiguous vertebrae with at least 5° of wedging anteriorly. Prevalence of the disease is thought to be between 0.4% and 10%. The true cause of SK remains unclear; however, various theories include growth irregularities, mechanical factors, genetic factors, and/or poor bone quality as the causes. Patients with mild disease (less than 70°) generally have a favorable prognosis with good clinical outcomes. Most patients with SK are successfully treated nonsurgically with observation, anti-inflammatory medications, and physical therapy. Surgical intervention is indicated in patients with greater than 70° to 75° thoracic curves, greater than 25° to 30° thoracolumbar curves, intractable pain, neurologic deficit, cardiopulmonary compromise, or poor cosmesis. Because of advances in posterior spinal instrumentation, surgery can typically be performed through a posterior-only approach. When surgical treatment is planned, appropriate selection of the upper- and lower-instrumented vertebrae is important to achieve a well-balanced spine, preserve motion segments, and reduce the risk of junctional kyphosis.

From the Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY (Dr. Sardar and Dr. Lenke), and the Department of Orthopaedic Surgery and Sports Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (Dr. Ames).

Correspondence to Dr. Sardar:

Dr. Lenke or an immediate family member has received IP royalties from Medtronic and Quality Medical Publishing; serves as a paid consultant to DePuy, K2M, and Medtronic; has received research and institutional support from AOSpine, Depuy, EOS, Scoliosis Research Society, and Setting Scoliosis Straight Foundation; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Evans Family Donation-grateful patient-philanthropic support, Fox Family Foundation-philanthropic research funding from grateful patient, and Fox Rothschild, LLC-expert witness in a patent infringement case; and serves as a board member, owner, officer, or committee member of Global Spine Outreach and Orthopaedic Research and Education Foundation. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Sardar and Dr. Ames.

© 2019 by American Academy of Orthopaedic Surgeons
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