What is the role of surgery in the treatment of Scheuermann disease (juvenile kyphosis)?

Updated: Sep 08, 2020
  • Author: Jozef E Nowak, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Surgery rarely is indicated in patients with Scheuermann's disease. Probably the two most common indications for surgery are spinal pain and unacceptable cosmetic appearance. These criteria are subjective, so it is wise to be cautious in counseling these patients. [7]

In patients with curves greater than 75° and with pain that is unresponsive to nonoperative measures, consider spinal fusion. Spinal fusion consists of an anterior release and fusion, as well as a posterior instrumentation and fusion performed under the same anesthesia on the same day. See the image below.

Postoperative lateral demonstrating a 2-rod levera Postoperative lateral demonstrating a 2-rod leverage technique after an anterior release allowing reduction of the deformity to 47º.

A retrospective study by Riouallon et al indicated that with regard to functional and radiologic results, the effectiveness and stability of posterior-only spinal fixation in Scheuermann’s disease are the same as for combined anterior/posterior fusion. The investigators therefore recommended that the condition be treated with the anterior/posterior approach only when major deformation is present. [22]

A multi-center, prospective cohort study by Polly et al indicated that patients with Scheuermann's disease who undergo spinal fusion tend to have a higher body mass index than those treated nonoperatively. [23]

Cord decompression is indicated for the rare patients who have neurologic deficits secondary to epidural cysts or increased kyphotic angulation.

The most frequently occurring complication is pseudoarthrosis, followed by instrumentation failure and secondary loss of correction.

The optimal treatment of Scheuermann's disease is controversial. Patients treated with bracing or surgery have experienced an improved self-image, which they have attributed to their treatment. Patients with kyphotic curves extending 70° at follow-up have had an inferior functional result. Soo and colleagues suggested that by carefully selecting the appropriate treatment for patients with Scheuermann's disease on the basis of the patient's age, the spinal deformity, and the severity of back pain, achieving a similar functional result at long-term follow-up is possible. [24] They felt that despite different treatment protocols, patients with Scheuermann's disease tend to achieve a similar functional result at long-term follow-up.

Flexible curves have been suggested as a positive predictor of a successful outcome of bracing.

Other variables that have positively influenced the outcome of treatment have been compliance with conservative treatments (a body cast plus brace and exercise regimen) and the initial presence of the Risser sign of skeletal maturity.

A retrospective study by Nasto et al indicated that in patients with Scheuermann's disease who undergo posterior-only surgical correction, high preoperative pelvic incidence should be taken into account when planning correction of thoracic kyphosis in order to avoid too much reduction of lumbar lordosis and the development of proximal junctional kyphosis. [25]

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