Scheuermann’s Disease: New Impressions of Clinical and Radiological Evaluation and Treatment Approaches; A Narrative Review

Abstract

Context: Scheuermann's disease (kyphosis) is an essential kyphosis of the thoracic spinal column, and it is the most public source of kyphosis in adolescents. It has been shown that the imaging characteristics of the disease are sequential 3 vertebrae by minimum 5 degrees of wedging of anterior part of vertebral body. Frequently, the disease is presented at 8 to 12 years of age. Kyphosis is regularly managed with conservative methods. The purpose of this review was to discuss challenging issues in evaluation and treatment of this disease in the mentioned age group. Evidence Acquisition: Medline, Google scholar, PubMed and Ovid were searched and a total of 44 articles were found to be involved in the pediatric evaluation of this disease.Results: The precise basis of Scheuermann's kyphosis remnants is unidentified. Diagnosis is made by careful clinical examination and radiologic evaluations. In neurologic defects, MRI must be taken. Conservative managing plans for SK involve observation, physical therapy, and bracing. Some writers recommended evading the operation till skeletal maturity is completed. Surgery is commonly suggested for patients with deformity progress, permanent pain, neurological discrepancy, pulmonary insufficiency, or cosmetic complain. Thoracic kyphosis with curving of smaller than 75 degrees seldom requires surgery. Posterior only or combined with anterior methods are the surgery options based on severity of disease. Conclusions: Today, new and more modern braces have been designed to increase global advantages of bracing in Scheuermann's disease. Patients with more than 75 degrees of curving, kyphotic progress, intolerable cosmetic features, or neurological discrepancy might be supposed for operation. New surgical procedures permit improved correction of the deformity via posterior surgery with lesser complication rates. Concurrent shortening of the posterior spinal column crossways the apical levels, combined by monitoring of spinal cord, decreases the danger of neurological deficits. Though patients state great satisfaction rates through surgery, both proximal and distal junctional complications can remain. New systems with dynamic instrumentation and improving surgical methods with biologic handling are almost convinced to become typical treatment possibilities.

The surgical management of scheurmann’s kyphosis: Efficacy and safety of a low density posterior pedicle screw construct

“…The posterior approach with osteotomies has become a popular alternative in recent years due to the link between advancements in spinal osteotomies and the development of strong fixation systems (pedicle screws that allow robust three-column fixation), resulting in shorter operation times and fewer comorbidities and problems (blood transfusion, decrease in pulmonary capacitance, hospitalisation times, and recovery times). [25][26][27][28][29] The ideal pedicle screw density (number of pedicle screws used/number of possible pedicle insertion sites) for maintaining a stable fixation following treatment of spinal abnormalities is still debated. High density screw (HDS) surgery takes longer and costs more money, and it also has a higher complication rate.…”

“…The posterior approach with osteotomies has become a popular alternative in recent years due to the link between advancements in spinal osteotomies and the development of strong fixation systems (pedicle screws that allow robust three-column fixation), resulting in shorter operation times and fewer comorbidities and problems (blood transfusion, decrease in pulmonary capacitance, hospitalisation times, and recovery times) 25–29 …”

Spinopelvic Alignment and Sagittal Balance in Adolescent Pa-tients with Structural Hyperkyphosis

“…The demographic and clinical data of the patients were recorded. Physical examinations of the patient's spine were performed and the differential diagnosis of HK was made according to thoracic spine magnetic resonance imaging as described in the literature (Haddadi et al, 2018). Patients who do not meet yet Scheuermann's disease diagnosis criteria due to the early phase of the disease development, presented as structural HK.…”