SCHEUERMANN’S DISEASE –

TREATMENT AND OUTCOME

Authors: Diana Plescan, Andrian Ciobanu, Sorin Cristea, Teodor Jipa, Alexandru Radulescu, Georgiana Nedelea

Department of Orthopaedic Surgery, Clinical Hospital of

Orthopaedics and Traumatology “Foișor”, Bucharest, Romania
 The “normal” kyphosis

Normal thoracic kyphosis – males and females – 10̊-40̊

Variations of the thoracic curve may be present with age,

so that a normal kyphosis of 40º to 50º may occur.
 Postural vs. Scheuermann’s kyphosis

• Usually less severe

• No wedging
• Non-structural
 Holger Werfel Scheuermann

(1877-1960)

• 1920-1921 describes the disease that carries his name

for the first time

• a condition for which several etiological theories have

been advanced, the cause of it still remaining unclear
- mechanical
- genetic
- metabolic
- endocrine
- others.
 Clinical examination

• early adolescence, exaggerated by the pubertal growth

spurt
• back pain
• rigid curve of the spine
• worsening of the kyphosis when bending forward
 Radiographic findings

• Sorenson criteria:
- a minimum of
three adjacent
vertebrae
- >5̊ anterior
wedging

• Apex usually T7-T9

In spite of the aesthetic aspect of the spine,
Scheuermann’s disease is a condition that rarely leads to
severe complications affecting the quality of the patient’s
life.
Indications for surgical treatment

• curves greater than 75̊

• curves rapidly progressing
• pain
• cosmetic
 Goals in surgery

• relieving pain
• maintaining the sagittal balance

• reduce the hyperkyphosis - by 50%

- <40̊
 Posterior surgical approach

• Ponte described his osteotomy

• Emergence of multi segmental pedicle screws

Fusion levels:
- proximal extension to T1-T3
- first lordotic segment distally
 Posterior-only approach

• 6 patients
• age between 14-21 years
• “less surgery means less complications”
Female, 16 years
 Three years

Five years
Two years
Male, 21 years
One year Two years
Male, 15 years
Female, 15 years
One year Two years
Female, 14 years

Two years
Female, 15 years
 Combined anterior and posterior approach

• 2 patients
• ages: 19 and 24 years old
• severe kyphosis
Male, 19 years
One year
Male, 24 years
 Postoperative care

• first postoperative day patient is allowed to sit out of bed

• an average hospitalization of 5 days
• physical activities restriction for up to 6 months.
 Conclusions

1. The actual tendency is pursuing a posterior-alone

approach in Scheuermann’s kyphosis correction.
2. Although a better correction is achieved with a
combined approach, more surgery implies more
complications.
3. Over time, loss of some correction is expected for every
deformity operation.