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What Is Scheuermann's Kyphosis?

The thoracic spine — the middle and upper back — typically has a curvature of 20 to 40 degrees. People who have more severely curved middle and upper backs are considered to have a spinal deformity, or kyphosis, and this "hunchback" or "round back" posture has many possible causes. Scheuermann's Kyphosis, also called Scheuermann's Disease, marked by misshapen vertebrae, is one such cause. 

Scheuermann's Kyphosis develops while a person is still growing, that is during childhood or adolescence. It falls under the category of osteochondrosis, disorders of the growing bone, and is likely caused by a combination of genetic factors, trauma/injury, vascular abnormalities, hormonal imbalances, and mechanical factors. 

Symptoms of Scheuermann's Kyphosis  generally show up between the ages of 10 and 15, the disease occurs more frequently in boys than in girls. 

Symptoms of Scheuermann's Kyphosis include:

  • Poor posture, which cannot be corrected with willpower alone. 
  • Pain in the middle section of the back, which can become severe with time. 
  • Fatigue
  • Stiffness 

Should you notice these symptoms in your child or your child complains of middle and upper back pain often, it is time to seek medical help. Diagnosis is made through a combination of physical examinations and X-rays.

How Is Scheuermann's Kyphosis Treated?

Scheuermann's Kyphosis is self-limiting after a person completes pubertal growth, meaning it will neither get worse nor better. The fact that Scheuermann's Kyphosis does not correct itself after puberty is finished means that early intervention is recommended in more severe cases, though mild and asymptomatic cases may simply be monitored.

Treatment most frequently consists of the wearing of a cast or brace that forces the vertebrae to continue forming in a more typical manner. The so-called Milwaukee Brace, also called cervico-thoraco-lumbo-sacral orthosis, is a prime choice. This brace is typically advised to be worn 23 hours a day, and can, in adolescents, result in very significant posture improvement within two years. In adults, this brace can still be used to relieve the pain associated with Scheuermann's Kyphosis, but correction of the spine's curvature will not be achieved. 

Physical therapy is also often recommended for patients with Scheuermann's Kyphosis, especially in Europe. This focuses on functional improvements, hamstring strengthening and trunk extensor strengthening. 

Where the curvature of the thoracic spine exceeds 70 degrees, surgery is commonly advised, especially in cases where the kyphosis has been shown to be progressive. This surgery has the aim of reducing the pain associated with Scheuermann's Kyphosis, however, surgery may also be a viable option in patients who are hoping to achieve cosmetic improvements. 

Surgery for Scheuermann's Kyphosis will involve spinal fusion of the abnormal vertebrae, which can be achieved in several ways, but typically includes the insertion of titanium rods and the loosening of ligaments, which help place the spine into a better position.

Since surgery can lead both to immediate complications and cause the need for follow-up operative procedures, however, and since the more conservative management — physiotherapy and the use of a back brace — is often sufficient, surgical treatment is a last-resort scenario. 

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