Relationship between Scheuermann disease and symptomatic thoracic spinal stenosis: A retrospective study.

OBJECTIVE: This study aimed to investigate the possible relationship between Scheuermann disease (SD) and the pathophysiological factors of thoracic spinal stenosis (TSS), including ossification of the ligamentum flavum (OLF), ossification of the posterior longitudinal ligament (OPLL), and thoracic disc herniation (TDH) in patients with symptomatic TSS. METHODS: Demographic and radiological data from 66 consecutive patients diagnosed with symptomatic TSS from 2013 to 2018 were retrospectively collected and divided into 3 groups depending on the underlying pathomechanism of TSS: TDH group (18 patients; 6 women; mean age ± standard deviation [Sd] = 59.89 ± 11.34), OPLL group (12 patients; 8 women; mean age ± Sd = 56.08 ± 14.74), and OLF group (36 patients; 20 women; mean age ± Sd = 58.69 ± 9.77). A total of 41 age-matched healthy individuals (19 women; mean age ± Sd = 54.88 ± 13.63) were designated as the control group. In each group, both typical and atypical SD criteria were radiologically examined. The demographic data and presence of SD between the control group and 3 subgroups of TSS pathomechanisms were evaluated. RESULTS: SD characteristics were identified in 83.33% (15/18) of patients in the TDH group, 44.44% (16/36) in the OLF group, 25% (3/12) in the OPLL group, and 17.07% (7/41) of the control individuals. When analyzed by the chi-squared test and logistic regression analysis, the presence of SD was significantly associated with TDH (P < 0.01) and OLF (P < 0.05) but not OPLL (P > 0.05). Patients with TDH and OLF showed peak involvement of T10/11, and patients with OPLL did not. Furthermore, we determined that age, sex, body-mass index, and smoking status were not the risk factors for TDH, OPLL, and OLF (P > 0.05). SD was found to be a risk factor for TDH (P < 0.01) and OLF (P < 0.05) but not for OPLL (P > 0.05). CONCLUSION: Evidence from this study indicated that SD might be a risk factor for OLF and TDH but not for OPLL.

Severe hyperkyphosis reduces the aerobic capacity and maximal exercise tolerance in patients with Scheuermann disease.

BACKGROUND CONTEXT: The evaluation of ventilatory functional restrictions during a maximal exercise tolerance test in patients with Scheuermann disease has never been described. PURPOSE: This study evaluated the respiratory functional capacity of patients with Scheuermann disease compared to healthy adolescents matched in age. STUDY DESIGN/SETTING: Prospective comparative study. PATIENTS SAMPLE: Forty-one consecutive adolescents with Scheuermann hyperkyphosis (SK) and 20 healthy controls matched in age were included in the study. OUTCOME MEASURES: Basal spirometry and dynamic ventilatory parameters were measured during a maximal cardiopulmonary exercise tolerance test. Heart rate, oxygen saturation (SatO2), maximum oxygen uptake (VO2 max), quotient between ventilation and volume of exhaled carbon dioxide (VE/CO2), respiratory exchange rate (RER), ventilatory capacity at maximal exercise (VEmax), and test duration were recorded at initium and at maximal exercise. METHODS: The exercise tolerance test (ETT) was completed to exhaustion using a standard Bruce protocol on a ramp treadmill. Comparisons of quantitative variables between SK and control group were analyzed by statistical nonparametric test. The correlations between the magnitude of the thoracic kyphosis and both the VO2 max/kg and VEmax of the SK group were also analyzed. No funds were required. The authors have no conflicts of interests. RESULTS: Patients with SK started the test with a higher heart rate (p<.01) and reached exhaustion with a lower heart rate (p<.05) than healthy controls. At maximal exercise, the SatO2 was declined in Scheuermann patients compared to healthy subjects (p<.05). The maximal aerobic power (VO2max) was greater in healthy controls than in hyperkyphotic patients (50.0±6.7 vs. 43.4±11.3 mL/kg/min; p<.05). There was an inverse correlation between the increase in the magnitude of thoracic kyphosis and the deterioration of the maximal aerobic power. VO2max and VEmax were severely deteriorated in patients with more than 75° kyphosis. Patients with >75° thoracic kyphosis also showed an impairment in their cardiovascular efficiency as measured by the heart rate/VO2 quotient. The limited tolerance to the exercise in SK patients was reflected by a shorter duration of the exercise test and a lower energy cost measured in METS (metabolic equivalents) as compared to healthy controls. CONCLUSIONS: Patients with severe hyperkyphosis (>75°) show significant respiratory inefficiency together with a lower ventilation capacity and lower VO2max. There is an inverse correlation between the increase in the magnitude of thoracic kyphosis and the deterioration of the maximal aerobic power.

Can MRI Predict Flexibility in Scheuermann Kyphosis Patients?

STUDY DESIGN: Retrospective, blinded analysis of imaging studies. OBJECTIVE: The aim of this study is compare the use of magnetic resonance imaging (MRI) to lateral radiograph using bolster in the evaluation of Scheuermann kyphosis (SK) curve flexibility measurement. SUMMARY AND BACKGROUND DATA: The flexibility of the thoracic curve [thoracic kyphosis (TK)] in SK is of primary importance in its preoperative planning. Several methods have been described for SK curve flexibility measurement. The most commonly used method is lateral hyperextension radiography on hard bolster [hyperextension radiograph (HE)]. No current methods use MRI for flexibility assessment. MATERIALS AND METHODS: Flexibility of TK in SK patients was measured as a difference between standing radiograph and bolster-assisted lateral HE or supine MRI. The sagittal Cobb angle of the TK was measured between the superior endplate of T4 and the inferior endplate of T12 vertebral body. Flexibilities measured by these 2 methods were compared and analyzed using the generalized estimating equation analysis and the correlation analysis. RESULTS: We assessed 18 SK patients (14 males and 4 females) with mean age of 20.06±6.03 years. The standing TK x-rays showed 83.8±6.1 degrees. On HE, TK curve reduced by 39.3 degrees (95% confidence interval, 35.8-42.9) to 44.5±6.2 degrees (P<0.001). Preoperative MRI images showed TK of 53.8±5.9 degrees which means reduction by 30 degrees (95% confidence interval, 26.6-33.4) from the standing radiographs (P<0.001). Linear dependency between HE and MRI flexibility with a mean difference of 9.3 degrees was found (R=0.61, P<0.001). CONCLUSIONS: Our study shows that preoperative MRI can be used for SK flexibility assessment with similar predictive value as routinely used bolster-assisted hyperextension lateral radiograph. Consequently, patient exposure to preoperative hyperextension ionizing radiation may be reduced.

Progression of untreated mild thoracic Scheuermann's kyphosis - Radiographic and functional assessment after mean follow-up of 46 years.

BACKGROUND: There is no data available on the radiographic development of the Scheuermann's deformity. Our purpose was to investigate radiographic deformity progression and the relation between kyphosis progression and clinical outcome in patients with untreated Scheuermann's kyphosis. METHODS: Thoracic kyphosis (Th4-Th12) was measured from standing lateral radiographs in 19 patients at baseline and after mean 46-year follow-up. Mean age at baseline was 19.2 and at follow-up 64.7 years. At follow-up, height, weight, hand grip strength, and hamstring tightness were measured, and sit-to-stand and walking tests were performed. Additionally general health and quality of life questionnaires were administered. RESULTS: The mean thoracic kyphosis increased from 46° (range 25°-78°) at baseline to 60° (34°-82°) (p < 0.001) at follow-up. Mean of the vertebrae wedge increased from 8.8° to 9.9° (p = 0.046). There was no correlation between extent of kyphosis progression and function at follow-up. CONCLUSIONS: Among patients with Scheuermann's disease the degree of radiographic deformity progressed slightly during long-term follow-up. Progression did not predict symptoms.

Craniosynostosis, Scheuermann's disease, and intellectual disability resembling Shprintzen-Goldberg syndrome: a report on a family over 4 generations: Case report.

RATIONALE: Craniosynostosis is a disorder characterized by premature fusion of cranial sutures with subsequent development of abnormal craniofacial contour associated with variable skeletal and extra-skeletal abnormalities. In this family syndromic type of craniosynostosis was recognized and the etiology behind diverse forms of deformities have been diagnosed. PATIENT CONCERNS: The negative impact of the disorder on the child and his family is enormous. Particularly when the diagnosis is late and little can be done. Though counselling the family through discussing the whole picture of the disorder might lessens their concern. DIAGNOSES: Diagnosis is the corner stone of management. In this paper we aimed to sensitize pediatricians, physicians, and orthopedic surgeons concerning the necessity to recognize syndromic associations early on. INTERVENTIONS: Patients with syndromic craniosynostosis are usually associated with a complexity of malformation complex. Craniofacial surgery can be of remarkable help if the diagnosis is made early. It requires a series of corrections to avoid intellectual disability and other neurological deficits.The timing of interventions is strongly correlated on the timing of diagnosis. OUTCOMES: The earliest the diagnoses, the much better the outcomes are. And consequently avert the psychological and the financial cost on the patient and his family. LESSONS: The golden principle of medicine should prevail in all medical disciplines, which states: The more you see, the more you know and conversely the more you know is the more you see.

Correlation between preoperative spinopelvic alignment and risk of proximal junctional kyphosis after posterior-only surgical correction of Scheuermann kyphosis.

BACKGROUND CONTEXT: Surgical correction of Scheuermann kyphosis (SK) is challenging and plagued by relatively high rates of proximal junctional kyphosis and failure (PJK and PJF). Normal sagittal alignment of the spine is determined by pelvic geometric parameters. How these parameters correlate with the risk of developing PJK in SK is not known. PURPOSE: The study aimed to investigate the relationship between preoperative and postoperative spinopelvic alignment and occurrence of PJK and PJF. STUDY DESIGN/SETTING: This is a retrospective observational cohort study. PATIENT SAMPLE: The sample included 37 patients who underwent posterior correction of SK from January 2006 to December 2012. OUTCOME MEASURES: The outcome measure was correlation analysis between preoperative and postoperative spinopelvic alignment parameters and the development of PJK over the course of the study period. METHODS: Whole spine x-rays obtained before surgery, 3 months after surgery, and at the latest follow-up were analyzed. The following parameters were measured: thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). The development of PJK was considered the primary end point of the study. Patient population was split into a control and a PJK group; repeated-measures analysis of variance was used to assess group and time differences. RESULTS: Seven patients developed PJK over the study period. Although the severity of the preoperative deformity (TK) did not differ significantly between the two groups, preoperative PI was significantly higher in the PJK group (51.9°C±8.6°C vs. 42.7°C±8.8°C, p=.018). Postoperative correction of TK was similar between the two groups (39.3% and 41.2%, p=.678) and final LL did not differ as well (53.6°C±9.2°C vs. 51.3°C±11.5°C). However, because PJK patients had larger preoperative PI values, a significant deficit of LL was observed at final follow-up in this group compared with the control group (ΔLL -10.5°C±9.8°C vs. 0.6°C±10.5°C, p=.013). CONCLUSIONS: Scheuermann kyphosis patients who developed PJK appeared to have a significant postoperative deficit of LL (lumbopelvic mismatch). Lumbar lordosis decreases after surgery following correction of TK; therefore, TK correction should be planned according to preoperative PI values to avoid excessive reduction of LL in patients with higher PI values.

Inter- and intratester reliability values of ultrasound imaging measurements of diaphragm movement in the thoracic and thoracolumbar curves in adolescent idiopathic scoliosis.

PURPOSE: The purpose of this study was to determine intertester and intratester reliability of ultrasound measurements of bilateral diaphragm excursions in the thoracic and thoracolumbar spinal curves of 31 females with adolescent idiopathic scoliosis (AIS) (mean age = 14.1 ± 1.8 years). METHOD: Subjects were tested during tidal breathing using real-time ultrasound imaging with a 3.5 MHz curvilinear transducer. RESULTS: There were no significant differences in intratester and intertester reliability values in bilateral diaphragmatic excursions measured at the thoracolumbar spinal curve, whereas significant differences were observed in measurements taken at the thoracic spinal curve (p < 0.05). Overall, the intertester and intratester reliabilities of the thoracic and thoracolumbar curves in AIS ranged from 0.764 to 0.998. CONCLUSIONS: These findings suggest that ultrasound imaging is highly reliable between and within testers and is useful to precisely discriminate pathological diaphragm movement in idiopathic thoracic scoliosis and idiopathic thoracolumbar scoliosis.

Cervical Sagittal Alignment in Scheuermann Disease.

STUDY DESIGN: Retrospective evaluation of radiographs. OBJECTIVE: The aim of this study was to assess sagittal cervical balance in patients with the two types Scheuermann disease (SD). SUMMARY OF BACKGROUND DATA: The structural hyperkyphosis characterizing SD may be localized in the thoracic (SDT) or thoraco-lumbar (SDTL) spine segments. This may affect sagittal cervical balance. METHODS: Seventy-one patients (41 males and 30 females), aged 16.3 ±â€Š3.8 years with SD, were enrolled into the study. On standing lateral long-cassette radiographs, the following measurements were made: C0-2 angle, C2-7 angle (CL), C1-C2 angle, relative rotation angle (RRA)-measured at levels from C2 to C7, cervical tilt (CT), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), C0-angle, cranial offset (CO), and cranial tilt (CRT). Comparison with t test was performed with significance level P < 0.05. RESULTS: There were 38 SDT and 33 SDTL patients. In SDT, the T1 slope was significantly greater than that in SDTL (38.1° vs. 28.9°; P = 0.0002), and consequently CL (-19.8° vs. -8.9°; P = 0.0160), CT (29.8° vs. 24.3°; P = 0.0190), and TIA (81.9° vs. 71.1°; P = 0.0022) in SDT were significantly greater as well. The difference in CL was expressed mainly in C6-C5 (-4.8° vs. -1.4°; P = 0.0146) and C5-C4 (-4.4°; vs. -1.5° P = 0.0464) segments. There were no significant differences in proximal cervical lordosis: C0-2 angle (-21.6° vs. -20.8°; P = 0.7597), C1-C2 angle (-30.8°vs. -27.5°; P = 0.1746), C3-C2 (-5.4° vs. -5.1°; P = 0.7976), and C4-C3 (3.5° vs. -1.5°; P = 0.1464) segments. There was no significant difference in cranial parameters C0-angle, CRT, and CO. CONCLUSION: Scheuermann disease type has an influence on cervical sagittal balance. Localization of structural kyphosis affects the T1 slope as well as C2-C7 lordosis, cervical tilt, and thoracic inlet angle. Significant difference in C2-C7 lordosis in comparison to similar C0-2 lordosis demonstrates that compensation is present in subaxial cervical spine. Position of the head center of gravity is not dependent on the SD type. LEVEL OF EVIDENCE: 4.

Does surgery for Scheuermann kyphosis influence sagittal spinopelvic parameters?

PURPOSE: To analyze changes in sagittal spinopelvic parameters (SSPs) after surgical treatment of Scheuermann's Kyphosis (SK). METHODS: We analyzed 20 patients affected by SK and subjected to posterior correction of the kyphosis by facetectomy, Ponte osteotomy, fusion and multilevel instrumentation with pedicle screw system. Four spinal and three pelvic parameters were measured: sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis, lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS) and pelvic tilt (PT). Analysis of changes in postprocedural SSPs compared to preoperative values was performed. RESULTS: TK passed from 78.6° preoperatively to 45.8° (p = 0.003). LL passed from 74.5° preoperatively to 53.5° (p = 0.01). No significant changes occurred in SVA, SS, PT and PI compared to preoperative values. CONCLUSION: We confirm the positive effect of surgery by Ponte osteotomy and posterior spinal fusion on TK and LL in patients with SK. In our experience, pelvic parameters did not change after surgery.

Vertebral Scheuermann's disease in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over.

UNLABELLED: In 27 centres across Europe, the prevalence of deforming spinal Scheuermann's disease in age-stratified population-based samples of over 10,000 men and women aged 50+ averaged 8% in each sex, but was highly variable between centres. Low DXA BMD was un-associated with Scheuermann's, helping the differential diagnosis from osteoporosis. INTRODUCTION: This study aims to assess the prevalence of Scheuermann's disease of the spine across Europe in men and women over 50 years of age, to quantitate its association with bone mineral density (BMD) and to assess its role as a confounder for the radiographic diagnosis of osteoporotic fracture. METHODS: In 27 centres participating in the population-based European Vertebral Osteoporosis Study (EVOS), standardised lateral radiographs of the lumbar and of the thoracic spine from T4 to L4 were assessed in all those of adequate quality. The presence of Scheuermann's disease, a confounder for prevalent fracture in later life, was defined by the presence of at least one Schmorl's node or irregular endplate together with kyphosis (sagittal Cobb angle >40° between T4 and T12) or a wedged-shaped vertebral body. Alternatively, the (rare) Edgren-Vaino sign was taken as diagnostic. The 6-point-per-vertebral-body (13 vertebrae) method was used to assess osteoporotic vertebral shape and fracture caseness. DXA BMD of the L2-L4 and femoral neck regions was measured in subsets. We also assessed the presence of Scheuermann's by alternative published algorithms when these used the radiographic signs we assessed. RESULTS: Vertebral radiographic images from 4486 men and 5655 women passed all quality checks. Prevalence of Scheuermann's varied considerably between centres, and based on random effect modelling, the overall European prevalence using our method was 8% with no significant difference between sexes. The highest prevalences were seen in Germany, Sweden, the UK and France and low prevalences were seen in Hungary, Poland and Slovakia. Centre-level prevalences in men and women were highly correlated. Scheuermann's was not associated with BMD of the spine or hip. CONCLUSIONS: Since most of the variation in population impact of Scheuermann's was unaccounted for by the radiological and anthropometric data, the search for new genetic and environmental determinants of this disease is encouraged.

Hypothesis about an existent biomechanical cause-effect relationship between Schëuermann's kyphosis and scoliosis.

Schëuermanns kyphosis is usually observed with a mild idiopathic scoliosis, and there is parity between these two diseases. The aim of this work is to establish a hypothesis about the existence of a biomechanical causal relationship between Schëuermann's kyphosis and scoliosis. To achieve this, a literature review was conducted. A simple mechanical model of the passive thoracolumbar subsystem was created to support part of the discussion. This mechanical model describes the passive thoracolumbar subsystem under ideal conditions of equilibrium. After giving consideration to the system under these conditions, some of the geometrical changes that may be found in Schëuermanns kyphosis are considered. Next, this work discusses the evolution of the spine, taking into account its relationship with stable equilibrium, which the passive subsystem tends toward. We hypothesized about the postural response of the body to compensate for possible situations of imbalance. In conclusion, it can be found that a change in the alignment of the spine may occur due to the postural adaptation of the body to an inadequate mechanical situation that may lead to scoliotic deformity of the spine.

The prevalence of abnormal preoperative neurological examination in Scheuermann kyphosis: correlation with X-ray, magnetic resonance imaging, and surgical outcome.

STUDY DESIGN: Retrospective. OBJECTIVE: The purpose of this study was to report the prevalence of abnormal neurological findings detected by physical examination in Scheuermann kyphosis and to correlate it to radiographs, magnetic resonance imaging (MRI) findings, and results of operative treatment. SUMMARY OF BACKGROUND DATA: There have been sporadic reports about abnormal neurological findings in patients with Scheuermann kyphosis. METHODS: Among 82 patients with Scheuermann kyphosis who underwent corrective surgery, 69 primary cases were selected. Patients' charts were reviewed retrospectively in terms of pre and postoperative neurological examinations. Sensory or motor change was defined as an abnormal neurological examination. Their duration, associated problems, and various parameters on preoperative radiographs and MRI examinations were also measured to search for any atypical findings associated with an abnormal neurological examination. RESULTS: There were 6 cases (9%) (group AbN), with an abnormal neurological examination ranging from severe myelopathy to a subtle change (e.g., sensory paresthesias on trunk). Five patients recovered to a normal neurological examination after corrective surgery. The remaining 1 patient with severe myelopathy also showed marked improvement and was ambulatory unassisted by 2-year follow-up. In patients with a normal neurological examination (group N, n = 63), only 1 patient had neurological sequelae because of anterior spinal artery syndrome after combined anterior-posterior correction. No preoperative radiographical parameters were significantly different between groups. Average age was 21.3 (AbN) and 18.6 (N) years (P = 0.55). Average preoperative T5-12 kyphosis was 69.0° (AbN) and 72.5° (N) (P = 0.61). Forty-two magnetic resonance images were obtained and all showed typical findings of Scheuermann kyphosis. Five patients in the AbN group (1 patient underwent computed tomography/myelography) and 37 patients in the N group underwent an MRI. CONCLUSION: The prevalence of abnormal neurological findings in Scheuermann kyphosis was 9%, emphasizing the importance of performing a detailed preoperative neurological examination. If congenital stenosis or a herniated thoracic disc is present, myelopathy can occur. No radiographical findings correlated with the abnormal preoperative neurological examinations. A normal MRI can exist in the face of an abnormal neurological examination, and conversely, a normal neurological examination can be seen with an abnormal MRI. Surgery was successful in alleviating abnormal neurological issues. LEVEL OF EVIDENCE: 4.

Scheuermann's disease: an update.

Scheuermann's disease is a juvenile osteochondrosis of the spine. It is a disease of the growth cartilage endplate, probably due to repetitive strain on the growth cartilage weakened by a genetic background. The radiographic aspects are related to the vertebral endplate lesions and include vertebral wedging, irregularity of the vertebral endplate, and Schmorl's node (intraossous disk herniation). Disc alterations are frequent and may be secondary to dysfunction of the disc-vertebra complex. The definitions of Scheuermann's disease are varied; it can refer to the classical form of juvenile kyphosis, described by Scheuermann as well as asymptomatic radiographic abnormalities. Lumbar involvement is probably as frequent as the thoracic form and might be more painful. The first-line treatment is medical and includes rehabilitation and bracing. The earlier the start of treatment, the better the outcome, which highlights the importance of early diagnosis. Surgery is uncommon and must be limited to severe involvement after failure of conservative treatment. The natural history of Scheuermann's disease is unknown, but it might be associated with increased risk of back pain. The evolution of thoracolumbar and lumbar disease is unknown.

Enfermedad de Scheuermann lumbar atípica: a propósito de 6 casos / Atypical lumbar Schuermann's disease: a presentation of 6 cases

La enfermedad de Scheuermann es el origen más común de cifosis de la columna dorsal en el adolescente. Es uno de los orígenes más comunes de la dorsalgia en este grupo de edad. Se trata de una enfermedad cuya localización más frecuente es la torácica, siendo generalmente indolora. La forma de enfermedad de Scheuermann en el raquis lumbar es menos conocida, pudiendo pasar desapercibida en la práctica clínica habitual. Esta entidad fue descrita por Blumenthal como enfermedad de Scheuermann lumbar atípica. La forma lumbar atípica consiste en la aparición de hernias de Schmorl en uno o 2 cuerpos vertebrales con estrechamiento del espacio interdiscal y cambios en los platillos vertebrales. Con mayor frecuencia es dolorosa, lo que puede ser confundida con afecciones traumáticas, infecciosas o tumorales. En la mayoría de los pacientes el estudio radiográfico es suficiente para establecer el diagnóstico y diferenciar ambas formas. Nuestra serie de 6 enfermos afectados de la forma atípica lumbar de la enfermedad de Scheuermann y diagnosticados por nosotros, presentaron una historia clínica de lumbalgias de repetición. Asociaban hernias de Schmorl y un aumento muy evidente del diámetro lateral en las proyecciones radiográficas de la columna lumbar. La afectación de un solo cuerpo vertebral fue la más predominante (50% de los casos) y la vértebra más comúnmente afectada fue la L4. Todos los pacientes se reincorporaron a sus actividades habituales tras ser tratados con medidas conservadoras de inmovilización temporal y antiinflamatorios durante los periodos de dolor (AU)

Scheuermann's disease is the most common cause of kyphosis in adolescence, and one of the most common causes of back pain in this age group. It is most commonly located in thoracic spine and is generally painless. Scheuermann's disease in the lumbar spine is less known and may go undetected in daily clinical practice. Blumenthal described this entity as atypical lumbar Scheuermann's disease. This form presents with Schmorl's hernias in one or two vertebral bodies, with narrowing of disc space and changes in the vertebral plates. It is more often painful and it can be confused with traumatic, infectious or tumor diseases. In most patients, a radiographic study is enough to establish the diagnosis and to differentiate both forms. Our series consists of six patients affected with the atypical form of lumbar Scheuermann's disease and diagnosed by us. All patients had a repeated history of back pain with associated Schmorl's hernias, and a very high increase in lateral diameter in radiographic views of the lumbar spine. Involvement of a single vertebral body was the most prevalent (50% of cases), and the 4th lumbar vertebra was the most commonly affected. All patients returned to normal activities after conservative treatment with temporary immobilization and NSAIDs during pain episodes (AU)

Rapidly progressive Scheuermann's disease in an adolescent after pectus bar placement treated with posterior vertebral-column resection: case report and review of the literature.

STUDY DESIGN: Case report and review of the literature. OBJECTIVE: This case illustrates the importance of the costosternal complex in maintaining the stability and alignment of the thoracic spine. The patient was iatrogenically destabilized by placement of a pectus bar leading to rapid symptomatic progression of his Scheuermann's kyphosis, ultimately requiring surgical correction. SUMMARY OF BACKGROUND DATA: Scheuermann's kyphosis is a disease process defined by strict radiographical and clinical criteria. Surgical treatment is generally recommended for curves greater than 75°. This case demonstrates the critical role of the costosternal complex in maintaining the stability of the thoracic spine. The patient described in this report underwent placement of a pectus bar for correction of symptomatic pectus excavatum. He subsequently developed a progressive symptomatic Scheuermann's kyphosis as a result of the destabilization of his costosternal complex. This patient ultimately required removal of the pectus bar and posterior instrumented kyphosis correction. METHODS: Progressive symptomatic Scheuermann's kyphosis (105°) corrected by removal of the pectus bar, T11 posterior vertebral-column resection and T4-L3 instrumented posterior spinal fusion. RESULTS: The patient had an uneventful immediate postoperative course. He was discharged neurologically intact with dramatic kyphosis correction and significant symptomatic improvement. Radiographs obtained 3 years postoperatively reveal stable thoracolumbar correction. CONCLUSION: The costosternal complex plays a critically important role in the intrinsic stability of the thoracic spine. Iatrogenic disruption of the costosternal complex can result in rapid progression of thoracic/thoracolumbar kyphosis in the setting of Scheuermann's disease.

Effect of Milwaukee brace on static and dynamic balance of female hyperkyphotic adolescents.

BACKGROUND: Biomechanical factors, such as spinal deformities can result in balance control disorders. OBJECTIVES: The purpose of this study was to examine the effect of bracing on static and dynamic balance control of hyperkyphotic female adolescents. STUDY DESIGN: Clinical trial. METHODS: A force platform was employed to record center of pressure (COP) parameters. Ten adolescents undergoing Milwaukee brace for hyperkyphosis and 14 normal subjects participated in the study. The COP data were collected with and without brace immediately on first day and after 120 days of continuous brace wear. RESULTS: No significant difference was found in dynamic and static balance tests with and without brace on the first day (P > 0.05). After 120 days, the values of COP displacement in functional reach to the right and left for the hyperkyphotic adolescents when performing without brace enhanced significantly compared to the first day. The forward reach distance was not significantly different between the normal and hyperkyphotic subjects (P = 0.361); however, hyperkyphotic participants had significantly smaller reach distance in the functional reach to the right (21.88 vs. 25.56 cm) and left (17.04 vs. 21.25 cm). CONCLUSION: It might be concluded that bracing had a possible effect on improvement of dynamic balance performance, because the subjects could reach the target in dynamic reach tests with higher displacement in sagittal plane without losing their balance control. Clinical relevance Little is known about the biomechanical aspects of brace wear in individuals with hyperkyphosis. This study investigated balance differences between the healthy and hyperkyphotic individuals, and outcomes of Milwaukee brace wear. It might provide some new insight into the conservative treatment of hyperkyphosis for clinicians and researchers.

Conceptos actuales sobre la enfermedad de Scheuermann: presentación clínica, diagnóstico y controversias sobre su tratamiento / Current concepts on Scheuermann kyphosis: clinical presentation, diagnosis and controversies around treatment

La cifosis de Scheuermann es una deformidad estructural de la columna torácica o toracolumbar, que aparece antes de la pubertad y empeora durante la adolescencia. Aunque generalmente de curso benigno, la información disponible acerca de su historia natural es muy escasa. En casos de enfermedad grave, la cifosis puede progresar durante la etapa adulta y ser causa de deformidad significativa y dolor incapacitante. El tratamiento conservador mediante rehabilitación y ortesis carece de evidencia científica. Se debe considerar el tratamiento quirúrgico ante la presencia de una cifosis progresiva y dolorosa, la aparición de compromiso neurológico, o deformidad inaceptable. Este conlleva un elevado riesgo de complicaciones graves que deben ser discutidas con el paciente y sus familiares. Hoy en día, gracias al desarrollo de modernas técnicas de instrumentación, la corrección de la deformidad es posible mediante un abordaje posterior único con menor incidencia de complicaciones. El acortamiento simultáneo de la columna posterior en los niveles apicales, y la monitorización espinal intraoperatoria reducen los riesgos de lesión neurológica (AU)

Scheuermann kyphosis is a structural deformity of the thoracic or thoracolumbar spine that develops prior to puberty and deteriorates during adolescence. There is limited information on its natural history but many patients are expected to have a benign course. Severe kyphosis can progress into adult life and cause significant deformity and debilitating back pain. Conservative treatment includes bracing and physical therapy, but although widely prescribed they have not been scientifically validated. Surgical treatment may be considered in the presence of a progressive kyphosis producing severe pain resistant to conservative measures, neurological compromise, or unacceptable deformity. This is associated with significant risks of major complications that should be discussed with the patients and their families. Modern techniques allow better correction of the deformity through posterior-only surgery with lower complication rates. Simultaneous shortening of the posterior vertebral column across the apical levels, along with spinal cord monitoring, reduces the risk of neurological deficits (AU)

Scheuermann kyphosis in nonhuman primates.

STUDY DESIGN: A cadaveric survey of the thoracic spines of extant species of nonbipedal primates for the presence of Scheuermann kyphosis. OBJECTIVE: To determine the presence and prevalence of Scheuermann kyphosis in quadrupedal species of the closest living relatives to humans to demonstrate that bipedalism is not an absolute requirement for the development of Scheuermann kyphosis. SUMMARY OF BACKGROUND DATA: The etiology of Scheuermann kyphosis remains poorly understood. Biomechanical factors associated with upright posture are thought to play a role in the development of the disorder. To date, Scheuermann kyphosis has been described only in humans and extinct species of bipedal hominids. METHODS: Thoracic vertebrae from 92 specimens of Pan troglodytes (chimpanzee) and 105 specimens of Gorilla gorilla (gorilla) from the Hamann-Todd Osteological Collection at the Cleveland Museum of Natural History were examined for Scheuermann kyphosis on the basis of Sorenson criteria and the presence of anterior vertebral body extensions and for the presence of Schmorl nodes. RESULTS: Two specimens of P. troglodytes (2.2%) were found to have anatomic features consistent with Scheuermann kyphosis including vertebral body wedging greater than 5° at 3 or more adjacent levels and the presence of anterior vertebral body extensions. One of the affected specimens (50%) demonstrated the presence of Schmorl nodes whereas 2 of the unaffected specimens (2.2%) had Schmorl nodes. None of the specimens of G. gorilla (0%) were found to have anterior vertebral body extensions characteristic of Scheuermann kyphosis or Schmorl nodes. CONCLUSION: Thoracic kyphotic deformity consistent with Scheuermann kyphosis exists in quadrupedal nonhuman primates. Bipedalism is not a strict requirement for the development of Scheuermann kyphosis, and the evolutionary origins of the disease predate the vertebral adaptations of bipedal locomotion.

[Current concepts on Scheuermann kyphosis: clinical presentation, diagnosis and controversies around treatment]. / Conceptos actuales sobre la enfermedad de Scheuermann: presentación clínica, diagnóstico y controversias sobre su tratamiento.

Scheuermann kyphosis is a structural deformity of the thoracic or thoracolumbar spine that develops prior to puberty and deteriorates during adolescence. There is limited information on its natural history but many patients are expected to have a benign course. Severe kyphosis can progress into adult life and cause significant deformity and debilitating back pain. Conservative treatment includes bracing and physical therapy, but although widely prescribed they have not been scientifically validated. Surgical treatment may be considered in the presence of a progressive kyphosis producing severe pain resistant to conservative measures, neurological compromise, or unacceptable deformity. This is associated with significant risks of major complications that should be discussed with the patients and their families. Modern techniques allow better correction of the deformity through posterior-only surgery with lower complication rates. Simultaneous shortening of the posterior vertebral column across the apical levels, along with spinal cord monitoring, reduces the risk of neurological deficits.

[Correction of adolescent kyphosis. What is the state of the art?]. / Korrektur der Adoleszentenkyphose : Was ist State of the Art?

Thoracic and thoracolumbar kyphosis is a common deformity in pediatric and adolescent populations. Kyphotic deformation of the spine is defined as a curve which shows an increase in the dorsal convex angulation. The most common causes of kyphosis in pediatric and adolescent populations are Scheuermann's disease, postural and congenital kyphosis. The fundamental principles of treatment are analysis of the kyphotic deformity and restoration or maintenance of sagittal balance. Clinically significant sagittal deformities can lead to severe pain, substantial cosmetic alterations, spinal cord dysfunction, problems with swallowing, gastrointestinal and cardiopulmonary complications. When the kyphotic deformity exceeds a certain point and conservative therapy options are no longer sufficient surgical intervention is indicated. The available operative options for treatment of the various types of pediatric and adolescent thoracolumbar kyphosis include dorsal instrumentation and fusion combined with ventral fusion and purely ventral instrumentation and fusion.