See Also

Pediatric Back Pain

Epidemiology

Most common structural kyphosis in teenagers,with typical onset age 10-12 years old (as early as 8 years old)

Precautions

Scheuermann's Kyphosis is often misdiagnosed as poor Posture (postural kyphosis)

Pathophysiology

Osteochondrosis affecting the Vertebral epiphyseal Growth Plates
Vertebral end plate disorder results in Vertebral body wedging
With growth spurt, kyphosis increases

Symptoms

Stooped Posture
Upper back pain
1. Gradual onset
2. Worse at end of day
3. Relieved with rest

Signs

Rigid kyphosis (humpback deformity) that does not improve with back extension or lying supine

Diagnosis

Three or more adjacent Vertebrae wedged >5 degrees and thoracic disc space narrowing
1. Draw lines from parallel to the top and bottom of the Vertebral bodies extended anteriorly
2. Measure wedging angle at the point at which the 2 lines intersect
  1. Lines do not intersect in a normal, non-wedged Vertebrae

Differential Diagnosis

Congenital kyphosis (formation or segmentation failure in development)
Neuromuscular kyphosis (Cerebral Palsy, Myelomeningocele, Syringomyelia, polio)
Postural kyphosis

Imaging

Thoracolumbar Xray
1. Lateral: Diagnosis requires 5 degrees or more of wedging in at least 3 adjacent Vertebrae
2. Also evaluate for Scoliosis and disc space narrowing
Thoracolumbar MRI
1. Indicated in severe symptoms and non-diagnostic XRay

Management

Physical Therapy
Bracing indications
1. Kyphosis 55-80 degrees before skeletal maturity
2. Bracing is poorly tolerated and rarely used in U.S.
Surgery indications
1. Kyphosis >80 degrees in Thoracic Spine
2. Kyphosis >65 degrees in thoracolumbar spine
3. Progressive or refractory course resulting in pain, neurologic deficit or balance concerns
4. Restrictive Lung Disease related symptoms and signs

Course

Progression is most pronounced during growth spurt and then slows after reaching skeletal maturity

References

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