Kyphosis refers to abnormal forward rounding of the back. Scheuermann’s kyphosis is a developmental type of “hunching” of the back. Instead of having the normal rectangular shaped vertebrae which stack easily, the vertebrae are wedge shaped which causes the spine to curve more than normal. This developmental abnormality occurs during adolescence while bones and the spine are still growing. Scheuermann’s kyphosis is twice as common in males as females and occurs in 5% of the population. Symptoms can include back and neck pain and severe Scheuermann’s kyphosis can block normal heart and lung function.
Signs and symptoms of Scheuermann’s kyphosis will slowly progress before puberty in the early teen years. Children may feel mild pain or fatigue in the mid-back. Parents may notice their child has slouching or poor posture. The back progressively rounds and hunches. Pain increases over time and is proportional to the degree of spinal curvature. About 30% of children with Scheuermann’s kyphosis also have scoliosis which is an abnormal lateral curvature of the spine. There are generally no nerve weakness or numbness but the curvature can restrict normal heart and lung function if severe.
Although Scheuermann’s kyphosis usually begins before puberty, it is unclear why it occurs. Holger Scheuermann was a Danish radiologist who first noticed the problem and worked to identify the cause. The ligament attached to the back of the vertebral bodies, the posterior longitudinal ligament, is thickened in patients with Scheuermann’s kyphosis which may cause or be caused by the condition.
You should contact your physician if you see any curvature of the spine. Your doctor will take a complete history and evaluate the spine with a physical exam looking for curvature. Your nerve function will be evaluated along with and muscle strength and skin sensation. Imaging tests can help your doctor identify issues with the spinal bones, heart, lungs and muscles. X-rays may be used to look spinal curvature or used at intervals to evaluate for worsening of the Scheuermann’s kyphosis. If the problem is just poor posture then no abnormalities will show up on the X-rays. A computed tomography (CT) scan uses the electromagnetic energy of X-rays to provide a detailed look at the bony anatomy spine and tissue around it. Evidence of three or more vertebrae in a row that have a 5 degree or more wedge is diagnostic of Scheuermann’s kyphosis.
Most children with mild Scheuermann’s kyphosis will not require treatment and just need monitoring to make sure the curvature is not worsening over time. With growth occurring and moderate Scheuermann’s kyphosis, your physician may recommend wearing a back brace which can prevent further progression of spinal curvature. Newer braces are form fitting and made of plastic to hide under clothing. The more the brace is worn the less progression of curvature there should be. A couple of years after puberty the brace does not need to be used but braces can be used in older patients to relieve fatigue and pain.
For more severe Scheuermann’s kyphosis with a curvature over 75 degrees, surgery may be required to reduce severe spinal curvature or to prevent progression. Fusing the abnormal spinal vertebrae is the most common surgery for Scheuermann’s kyphosis. Spinal fusion involves permanently attaching the abnormal spinal vertebrae together using bone grafts with plastic or metal screws and rods. This permanently fuses the spine vertebrae both posteriorly and anteriorly in the attached segments. This also requires general anesthesia and a short hospital stay.
Scheuermann’s kyphosis can be successfully treated especially if diagnosed and treated early. The neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis and surgical treatment of Scoliosis. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).