European Spine Journal

, Volume 14, Issue 9, pp 817–827 | Cite as

Scheuermann’s kyphosis: surgical management



Indications for surgery in Scheuermann disease are not well codified and remain rare, as the natural history of the disease is in most cases benign. In the immature adolescent, conservative treatment, such as bracing or casting, can be tried for moderate curves. For larger curves, or in the adult, conservative treatment is usually not effective, and surgery can be considered. Such indications are mostly cosmetic for large curves above 75°. Pain over the deformity or in the low back may represent another surgical indication, especially in the adult group. The question of anterior release or straight posterior fusion has become more of an actuality with the advent of powerful, third-generation stiff segmental instrumentation. However, the long-term results of a modern, posterior-only instrumentation fusion are not known. Concern about loss of correction, late pseudarthrosis or the need to remove instrumentation for infected hardware or due to late pain at the operative site must make us careful about choosing this method. Very rigid and large curves still require an anterior release, either done in a conventional or mini-open fashion, or through video-assisted thoracoscopic surgery. The extent of the posterior instrumentation has now been better defined. One must fuse the whole Cobb angle without hypercorrection and stop distally, above the first lordotic disc, to avoid sagittal decompensation. New approaches such as short anterior fusion with bone-on-bone techniques and pedicle substraction osteotomies have not yet been reported in the literature as having been used for treating Scheuermann’s kyphosis. These should be considered experimental.


Scheuermann’s kyphosis Spinal fusion 


  1. 1.
    Arlet V (2000) Anterior thoracoscopic spine release in deformity surgery: a meta-analysis and review. Eur Spine J 9 [Suppl 1]: S17–23Google Scholar
  2. 2.
    Ascani E, LaRosa G (1994) Scheuermann’ kyphosis. In: Weinstein SL (ed) The pediatric spine. Principles and practice. Raven Press, New York, pp 557–585Google Scholar
  3. 3.
    Aufdenmaur E (1981) Juvenile kyphosis (Scheuermann’s disease) Radiography, histology and pathogenesis. Clin Orthop 154:166–174Google Scholar
  4. 4.
    Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 14:717–721PubMedGoogle Scholar
  5. 5.
    Bhojraj SY, Dandawate AV (1994) Progressive cord compression secondary to thoracic disc lesions in Scheuermann’s kyphosis managed by posterolateral decompression, interbody fusion and pedicular fixation. A new approach to management of a rare clinical entity. Eur Spine J 3:66–69Google Scholar
  6. 6.
    Bradford DS, Moe JH, Montalvo FJ, Winter RB (1974) Scheuermann’s kyphosis and roundback deformity. Results of Milwaukee brace treatment. J Bone Joint Surg Am 56:740–758Google Scholar
  7. 7.
    Bradford DS, Moe JH, Montalvo FJ, Winter RB (1975) Scheuermann’s kyphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients. J Bone Joint Surg Am 57:439–448Google Scholar
  8. 8.
    Bradford DS, Ahmed KB, Moe JH, Winter RB, Lonstein JE (1980) The surgical management of patients with Scheuermann’s disease: a review of twenty-four cases managed by combined anterior and posterior spine fusion. J Bone Joint Surg Am 62:705–712Google Scholar
  9. 9.
    Bruns I, Heise U (1994) Spastic paraparesis in Scheuermann disease: a case report. Z Orthop Ihre Grenzgeb 132:390–393Google Scholar
  10. 10.
    Chiu KY, Luk KD (1995) Cord compression caused by multiple disc herniations and intraspinal cyst in Scheuermann’s disease. Spine 20:1075–1079Google Scholar
  11. 11.
    Cook S, Asher M, Lai SM, Shobe J (2000) Reoperation after primary posterior instrumentation and fusion for idiopathic scoliosis. Toward defining late operative site pain of unknown cause. Spine 25(4):2516–2517Google Scholar
  12. 12.
    Coscia MF, Bradford DS, Ogilvie JW (1988) Scheuermann’s kyphosis results in 19 cases treated by spinal arthrodesis and Luque instrumentation. Orthop Trans 12:255Google Scholar
  13. 13.
    Fon GT, Pitt MJ, Thies AC Jr (1980) Thoracic kyphosis: range in normal subjects. AJR Am J Roentgenol 134:979–983Google Scholar
  14. 14.
    Gutowski WT, Renshaw TS (1988) Orthotic results in adolescent kyphosis. Spine 13:485-489Google Scholar
  15. 15.
    Hammerberg EM, Wood KB (2003) Sagittal profile of the elderly. J Spinal Disord Tech 2003 16:44–50Google Scholar
  16. 16.
    Hosman AJ, Langeloo DD, de Kleuver M, Anderson PG, Veth RP, Slot GH (2002) Analysis of the sagittal plane after surgical management for Scheuermann’s disease: a view on over correction and the use of an anterior release. Spine 2:167–175Google Scholar
  17. 17.
    Hosman AJ, de Kleuver M, Anderson PG, van Limbeek J, Langeloo DD, Veth RP, Slot GH (2003) Scheuermann kyphosis: the importance of tight hamstrings in the surgical correction. Spine 19:2252–2259Google Scholar
  18. 18.
    Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103CrossRefPubMedGoogle Scholar
  19. 19.
    Liljenqvist U, Steinbeck J, Niemeyer T, Halm H, Winkelmann W (1999) Thoracoscopic interventions in deformities of the thoracic spine. Z Orthop Ihre Grenzgeb. 137:496–502Google Scholar
  20. 20.
    Lowe TG (1987) Double L-rod instrumentation in the treatment of severe kyphosis secondary to Scheuermann’s disease. Spine 12: 336–341Google Scholar
  21. 21.
    Lowe TG (1999) Scheuermann’s disease. Orthop Clin North Am 30:475–487Google Scholar
  22. 22.
    Lowe TG, Kasten MD (1994) An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann’s disease. A review of 32 patients. Spine 19:1680–1685Google Scholar
  23. 23.
    McKenzie L, Sillence D (1992) Familial Scheuermann disease: a genetic and linkage study. J Med Genet 29:41–45Google Scholar
  24. 24.
    Montgomery SP, Erwin WE (1981) Scheuermann’s kyphosis—long-term results of Milwaukee braces treatment. Spine 6:5–8Google Scholar
  25. 25.
    Murray PM, Weinstein SL, Spratt KF (1993) The natural history and long-term follow-up of Scheuermann kyphosis. J Bone Joint Surg Am 75 (2): 236–248Google Scholar
  26. 26.
    Newton PO, Shea KG, Granlund KF (2000) Defining the pediatric spinal thoracoscopy learning curve: sixty-five consecutive cases. Spine 25:1028–1035Google Scholar
  27. 27.
    Ogilvie JW, Sherman J (1987) Spondylolysis in Scheuermann’s disease. Spine 12:251–253Google Scholar
  28. 28.
    Otsuka NY, Hall JE, Mah JY (1990) Posterior fusion for Scheuermann’s kyphosis. Clin Orthop 251:134–139Google Scholar
  29. 29.
    Papagelopoulos PJ, Klassen RA, Peterson HA, Dekutoski MB (2001) Surgical treatment of Scheuermann’s disease with segmental compression instrumentation. Clin Orthop 386:139–149Google Scholar
  30. 30.
    Platero D, Luna JD, Pedraza V (1997) Juvenile kyphosis: effects of different variables on conservative treatment outcome. Acta Orthop Belg 63:194–201Google Scholar
  31. 31.
    Ponte A, Siccardi GL, Ligure P (1995) Posterior shortening procedure by segmental closing wedge osteotomies (abstract). J Pediatr Orthop 15:404Google Scholar
  32. 32.
    Poolman RW, Been HD, Ubags LH (2002) Clinical outcome and radiographic results after operative treatment of Scheuermann’s disease. Eur Spine J 11:561–569Google Scholar
  33. 33.
    Reinhardt P, Basset GS (1990) Short segmental kyphosis following fusion for Scheuermann’s disease. J Spinal Disord 3(2):162–168Google Scholar
  34. 34.
    Ryan MD, Taylor TK (1982) Acute spinal cord compression in Scheuermann’s disease. J Bone Joint Surg Br 64:409–412Google Scholar
  35. 35.
    Sachs B, Bradford D, Winter R, Lonstein J, Moe J, Willson S (1987) Scheuermann kyphosis. Follow-up of Milwaukee-brace treatment. J Bone Joint Surg Am 69:50–57Google Scholar
  36. 36.
    Scheuermann HW (1921) Kyphosis Dorsalis Juvenilis. Orthop Chir 41:305Google Scholar
  37. 37.
    Scoles PV, Latimer BM, Di Giovanni BF, Vargo E, Bauza S, Jellema LM (1991) Vertebral alterations in Scheuermann’s kyphosis. Spine 16:509–515Google Scholar
  38. 38.
    Soo CL, Noble PC, Esses SI (2002) Scheuermann kyphosis: long-term follow-up. Spine J 2:49–56Google Scholar
  39. 39.
    Sorenson KH (1964) Scheuermann’s kyphosis: clinical appearance, radiography, etiology and prognosis. Munsksgaard, CopenhagenGoogle Scholar
  40. 40.
    Speck GR, Chopin DC (1986) The surgical treatment of Scheuermann’s kyphosis. J Bone Joint Surg Br 68:189–193Google Scholar
  41. 41.
    Stambough JL, VanLoveren HR, Cheeks ML (1992) Spinal cord compression in Scheuermann’s kyphosis: case report. Neurosurgery 30(1):127–130Google Scholar
  42. 42.
    Sturm PF, Dobson JC, Armstrong GW (1993) The surgical management of Scheuermann’s disease. Spine 18:685–691Google Scholar
  43. 43.
    Tribus CB (1998) Scheuermann’s kyphosis in adolescents and adults: diagnosis and management. J Am Acad Orthop Surg 6:36–43Google Scholar
  44. 44.
    Tribus CB (2001) Transient paraparesis: a complication of the surgical management of Scheuermann’s kyphosis secondary to thoracic stenosis. Spine 26:1086–1089Google Scholar
  45. 45.
    Wenger DR, Frick SL (1999) Scheuermann kyphosis. Spine 24:2630–2639Google Scholar
  46. 46.
    Wood KB, Garvey TA, Gundry C, Heithoff KB (1995) Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg Am 11:1631–1638Google Scholar
  47. 47.
    Yablon JS, Kasdon DL, Levine H (1988) Thoracic cord compression in Scheuermann’s disease. Spine 8:896–898Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity of VirginiaCharlottesvilleUSA
  2. 2.ORTON Orthopedic Hospital Invalid FoundationHelsinkiFinland

Personalised recommendations