Blog Topic: Thoracic Scheuermann’s Kyphosis
What is thoracic kyphosis? From the side the human spine is wavy, unlike the view from the front in which it should be straight. The only part of the spine with kyphosis is the thoracic spine, the cervical and lumbar spine are in lordosis.
How much thoracic kyphosis is normal? In general normal kyphosis is in the 20-50 degree range. A higher degree of kyphosis is called hyper-kyphosis
What are the different types of hyper-kyphosis? There are broad, and sometimes overlapping, sub-groups in hyper-kyphosis:
1. 1. Congenital: parts of the spine never developed or separated or both
2. 2. Postural: this type of increased kyphosis is flexible, some is of thought of “slouching”. When they lay down the kyphosis improves
3. 3. Syndromic/Neuromuscular
4. 4. Post-traumatic: after a spine fracture
5 5. Scheuermann’s
What is Thoracic Scheuermann’s Kyphosis?
Angular wedging >5 degrees per level over 3 consecutive levels, called Sorensen’s criteria. Instead of the vertebra being the normal rectangular shape, they become trapezoidal, shorter in the front than in the back.
How does is develop? No one is exactly certain, but we do know it is due to asymmetric growth of the vertebra which occurs during the pubertal growth spurt, the second fastest time of spine growth. So the individuals are normal alignment when they are 9-10 years of age and then develop more and more kyphosis as they go through puberty.
Is it due to sports or wearing a heavy backpack? No
Can it be prevented? If it is identified very early bracing may be an option to prevent worsening.
What are the main symptoms of Scheuermann’s?
1. The obvious physical changes of the body, the pronounced angular deformity of the back.
2. Back pain. Pain develops over the angular area of the back and also the low back, which needs to hyperextend to compensate for the increased thoracic kyphosis.
Can physical therapy help? Physical therapy can help the back pain related to Scheuermann’s. Working on aerobic conditioning and strengthening the back and core musculature can decrease pain. However, it will not change the Scheuermann’s deformity.
When is surgery an option? In general surgery is an options for deformities greater than 75 degrees and the patient is having significant back pain which is not responsive to nonsurgical management (physical therapy, over-the-counter medications, weight loss, aerobic conditioning).
Does surgery have to be done for deformities >75 degrees? No. If the person doesn’t have significant pain then surgery is not needed.
What is the long-term implications of Thoracic Scheuermann’s Kyphosis? Mainly pain. All the other quality of life measures, such as function, job, etc… is the same with and without Scheuermann’s kyphosis.
The next blog post will be on the surgery for Thoracic Scheuermann’s Kyphosis……