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The Bone & Joint Journal Jan 2021To report the surgical outcome of patients with severe Scheuermann's kyphosis treated using a consistent technique and perioperative management.
AIMS
To report the surgical outcome of patients with severe Scheuermann's kyphosis treated using a consistent technique and perioperative management.
METHODS
We reviewed 88 consecutive patients with a severe Scheuermann's kyphosis who had undergone posterior spinal fusion with closing wedge osteotomies and hybrid instrumentation. There were 55 males and 33 females with a mean age of 15.9 years (12.0 to 24.7) at the time of surgery. We recorded their demographics, spinopelvic parameters, surgical correction, and perioperative data, and assessed the impact of surgical complications on outcome using the Scoliosis Research Society (SRS)-22 questionnaire.
RESULTS
The mean follow-up was 8.4 years (2 to 14.9). There were 85 patients (96.6%) with a thoracic deformity. Posterior spinal fusion with closing-wedge osteotomies and hybrid instrumentation was used in 86 patients; two patients underwent combined anterior and posterior spinal fusion. The mean kyphosis was corrected from 94.5° to 47.5° (p < 0.001). Coronal and sagittal balance returned to normal. The rate of complications was 12.5%: there were no neurological deficits, implant failure, or revision surgery. SRS-22 scores improved from a mean 3.6 (1.3 to 4.1) to 4.6 (4.2 to 5.0) at two years (p < 0.001) with a high rate of patient satisfaction. Non-smokers and patients with lower preoperative SRS-22 scores showed greater improvement in their quality of life. Sagittal pelvic balance did not change after correction of the kyphosis and correlated with lumbar lordosis but not with thoracic or thoracolumbar kyphosis.
CONCLUSION
Posterior spinal fusion using hybrid instrumentation, closing-wedge osteotomies, and iliac bone grafting achieves satisfactory correction of a severe kyphosis resulting in improvements in physical and mental health and a high degree of patient-reported satisfaction. Cite this article: 2021;103-B(1):148-156.
Topics: Adolescent; Female; Humans; Male; Osteotomy; Scheuermann Disease; Spinal Fusion; Surveys and Questionnaires; Young Adult
PubMed: 33380189
DOI: 10.1302/0301-620X.103B1.BJJ-2020-1279.R2 -
Studies in Health Technology and... 2002In our rehabilitation centre, the treatment of Scheuermann's disease consists of a daily postural education, lasting several hours. As for pain therapy, we mainly apply...
In our rehabilitation centre, the treatment of Scheuermann's disease consists of a daily postural education, lasting several hours. As for pain therapy, we mainly apply physiotherapeutic methods with osteopathy, manual therapy, Mc Kenzie and Brügger. In addition, we offer psychological help for pain relief. In case of severe chronic pain, we additionally treat it with acupuncture. Pain therapy with medication is only performed in rare cases. The aim of the present study was to find out if such an intensive rehabilitation programme had any effect on pain level in patients with Scheuermann's disease. An Intervention study (pre-/post-design) was undertaken including the following material: 351 patients suffering from Scheuermann's disease reported their pain level before and after an inpatient treatment. For this aim, we used a visual analog scale (VAS), a numerical scale (NS), a standardised adjective scale (VRS) and a pain frequency scale. In our group, there were 61 female patients with a thoracolumbar Scheuermann's disease, 121 female patients with a thoracic Scheuermann's disease, 92 male patients with a thoracolumbar Scheuermann's disease and 77 male patients with a thoracic Scheuermann's disease. The average age was 17 to 21 years old with an average kyphotic angle varying in the individual groups between 53 and 64 degrees. In the case of the numerical pain severity scale, pain severity was for example 2,9 in female patients with thoracolumbar Scheuermann's disease. In female patients with thoracic Scheuermann's disease, pain severity was also at 2.9. In male patients with thoracolumbar Scheuermann's disease, it was at 2.0 and in male patients with thoracic Scheuermann's disease, it was at 1.9. This numerical pain scale showed highly significant changes in pain severity: 2.1 in female patients with thoracolumbar Scheuermann's disease, 1.9 in female patients with thoracic Scheuermann's disease, 1.4 in male patients with thoracolumbar Scheuermann's disease and 1.8 in male patients with thoracic Scheuermann's disease. There was also a significant decrease in pain frequency. Seen as a whole, each scale showed a pain reduction between 16 and 32%, which is significant in all the cases and even highly significant in some cases. The in patient rehabilitation seems to have a positive effect on pain level in patients with Scheuermann's disease. In case of Scheuermann's disease in adult age, treatment is only indicated when patients suffer from pain. For those reasons, an in-patient intensive program of rehabilitation in a clinic with adequate quality structure should be considered.
Topics: Adolescent; Adult; Female; Humans; Male; Pain; Patient Education as Topic; Physical Therapy Modalities; Posture; Program Evaluation; Scheuermann Disease
PubMed: 15456045
DOI: No ID Found -
Spine Sep 2007: A review of the current literature using evidence-based medicine (EBM) regarding etiology, natural history, and treatment of Scheuermann kyphosis. (Review)
Review
STUDY DESIGN
: A review of the current literature using evidence-based medicine (EBM) regarding etiology, natural history, and treatment of Scheuermann kyphosis.
OBJECTIVE
: To provide current concepts for the rational evaluation and treatment of Scheuermann kyphosis supported by EBM.
SUMMARY OF BACKGROUND DATA
: The literature concerning etiology, natural history, and treatment of Scheuermann disease has mixed views and recommendations, most of which are not strongly supported with levels of evidence.
METHODS
: A thorough database search was performed in order to obtain the best current information and levels of evidence on etiology, natural history, and treatment options for Scheuermann kyphosis based on EBM criteria.
RESULTS AND CONCLUSION
: Scheuermann kyphosis is the most common cause of hyperkyphosis in adolescence. Its true etiology remains unknown, but there appears to be a strong genetic as well as an environmental contribution. The kyphotic deformity is frequently attributed to "poor posture" resulting in delayed diagnosis, and treatment indications remain debated because the natural history has not been clearly defined. When recognized early in adolescence with progressive kyphosis, bracing treatment will usually result in modest correction of the deformity. Symptomatic adolescents with severe deformity have demonstrated significant deformity correction following surgical intervention; however, clinical outcomes data are not yet available, and the studies available do not have strong levels of evidence.
Topics: Adolescent; Evidence-Based Medicine; Humans; Kyphosis; Scheuermann Disease
PubMed: 17728677
DOI: 10.1097/BRS.0b013e3181354501 -
Medicine Jun 2017Given that Scheuermann disease rarely occurs in the lumbar region and that the co-occurrence of Scheuermann disease and idiopathic scoliosis (IS) has not been...
RATIONALE
Given that Scheuermann disease rarely occurs in the lumbar region and that the co-occurrence of Scheuermann disease and idiopathic scoliosis (IS) has not been reported-the etiology of Scheuermann disease and IS is not clear. In this case report, we present familaiar lumbar Scheuermann disease with IS, in a Chinese proband, who was successfully treated with surgery.
PATIENT CONCERNS
A 16-year-old boy presented at the Second XiangYa Hospital of Central South University with a chief complaint of kyphotic deformity in the lower back for 4 years and obvious lower back pain. In addition, he complained of limited lumbar activity. And The proband's family history was obtained by routine inquiring. In this Chinese family with 17 members over 3 generations. The 3 patients (proband, proband's sister and father) shared the characteristics of vertebral wedging from L1 to L3 and a kyphosis Cobb angle of 37°, 70°, or 73°, respectively. The main deformity of the proband's mother was at T7-L1 with a Cobb angle of 102° in the coronal plane at T7-L1, thoracic kyphosis of 73°, and lumbar lordosis of 62°.
DIAGNOSES
Scheuermann's disease.
INTERVENTIONS
Clinical history, physical examination, laboratory tests, and radiographs of those in the pedigree were recorded, and the related literature was reviewed. The proband accepted osteotomy and orthopedic surgery for treatment.
OUTCOMES
After 3 months of treatment, postoperative lateral radiographs showed a significantly improved sagittal vertical axis (SVA). The other patients were continued to be seen in follow-up visits.
LESSONS
This series of lumbar Scheuermann patients with IS in a pedigree support the genetic contribution to Scheuermann disease. Therefore, this study provides some insight into the genetic etiology of Scheuermann disease with IS.
Topics: Adolescent; China; Diagnosis, Differential; Humans; Lumbar Vertebrae; Male; Scheuermann Disease; Scoliosis
PubMed: 28640085
DOI: 10.1097/MD.0000000000007100 -
European Spine Journal : Official... May 2012There are only a few follow-up studies of untreated Scheuermann's disease. The aim of this study was to investigate the relationship between vertebral changes, back...
INTRODUCTION
There are only a few follow-up studies of untreated Scheuermann's disease. The aim of this study was to investigate the relationship between vertebral changes, back pain, and disability in patients with untreated Scheuermann's disease after a 37-year follow-up.
MATERIALS AND METHODS
Eighty patients responded to a postal questionnaire concerning back pain and disability and 49 of them had classic Scheuermann's disease. Degree of kyphosis, lordosis, scoliosis, the number of affected vertebrae, and mean and maximum wedge angles were measured from radiographs. Back pain and disability scores were compared to a sample of the general Finnish population (n = 3,835).
RESULTS
At follow-up, the patients were on average 59 (SD 8) years old (range 44-79 years), and the mean follow-up time was 37 (SD 7) years (26-54 years). The patients comprised more males than females (3.1:1). At follow-up, male patients were on average 3 cm taller than controls (p = 0.007). At age 20, female patients compared to controls were on average 6 kg heavier (p = 0.016) and had higher body mass index (BMI) (mean 23.9 kg/m(2) vs. 20.8 kg/m(2), p = 0.001). Scheuermann's patients had 2.5-fold [odds ratio (OR); 95% confidence interval (CI); 1.4-4.5, p = 0.003] increased risk for constant back pain compared to controls. The risk for disability because of back pain during the past 5 years (OR 2.6; 95% CI 1.4-4.7, p = 0.002), risk for back pain during the past 30 days (OR 3.7; 95% CI 1.9-7.0, p < 0.001) and risk for sciatic pain (OR 2.3; 95% CI 1.3-4.3, p = 0.005) were higher compared to controls. Scheuermann's patients had higher risk for difficulties in mounting stairs (OR 5.4; 95% CI 2.8-10.3, p < 0.001) and in carrying a 5 kg load for at least 100 m (OR 7.2; 95% CI 3.9-13.3, p < 0.001).
CONCLUSION
Scheuermann's patients had a higher risk for back pain and disabilities during activities of daily living than controls. However, the degree of thoracic kyphosis among Scheuermann's patients was not related to back pain, quality of life, or general health.
Topics: Adult; Aged; Back Pain; Case-Control Studies; Disability Evaluation; Disease Progression; Female; Follow-Up Studies; Humans; Kyphosis; Longitudinal Studies; Male; Middle Aged; Prevalence; Quality of Life; Radiography; Risk Factors; Scheuermann Disease; Spine; Surveys and Questionnaires
PubMed: 22101868
DOI: 10.1007/s00586-011-2075-0 -
Journal of Orthopaedic Science :... Sep 2019There is insufficient knowledge of the epidemiology of Scheuermann's disease. The data available comes from estimations from young adults with obvious deformity, from...
BACKGROUND
There is insufficient knowledge of the epidemiology of Scheuermann's disease. The data available comes from estimations from young adults with obvious deformity, from studies evaluating children who may not have developed the deformity yet, or from older populations who can develop vertebral wedging secondary to other causes. We aimed to determine the prevalence of Scheuermann's disease in patients 15-40 years old using plain chest radiographs as a screening tool.
METHODS
We evaluated 454 patients aged 15-40 years old studied using standing plain chest radiographs. We measured thoracic kyphosis from T5 to T12; using the intraclass correlation coefficient (ICC), we determined inter- and intra-observer agreement. To determine the prevalence of Scheuermann's disease we used the Sorensen criteria. We performed a correlation analysis of thoracic kyphosis and age, and a linear regression to determine the impact of age and sex on the kyphosis angle.
RESULTS
The prevalence of Scheuermann's disease was 2.2% (0.9-3.5%). The prevalence was not different in females (1.4%) and males (2.8%), p = 0.36. Inter-and intra-observer agreements were excellent: ICC = 0.93 (0.84-0.97) and 0.97 (0.95-0.98). There was a small positive correlation of kyphosis angle with age (r = 0.110; p = 0.019). Linear regression revealed that age (ß = 0.138; p = 0.019) was an independent predictor of kyphosis angle, but sex was not (ß-coefficient = 0.007; p = 0.994).
CONCLUSION
We found a prevalence of Scheuermann's disease of 2.2%, without significant differences between males and females. Age independently influenced the kyphosis angle; sex did not. This study allows a better understanding of the epidemiology of Scheuermann's disease.
Topics: Adolescent; Adult; Age Factors; Chile; Female; Humans; Kyphosis; Male; Radiography, Thoracic; Scheuermann Disease; Sex Factors; Young Adult
PubMed: 30685093
DOI: 10.1016/j.jos.2018.12.024 -
American Journal of Physical Medicine &... Feb 1993
Topics: Contracture; Humans; Lumbar Vertebrae; Movement; Muscles; Scheuermann Disease
PubMed: 8431267
DOI: 10.1097/00002060-199302000-00010 -
Spine Feb 2013Case report and review of the literature. (Review)
Review
Rapidly progressive Scheuermann's disease in an adolescent after pectus bar placement treated with posterior vertebral-column resection: case report and review of the literature.
STUDY DESIGN
Case report and review of the literature.
OBJECTIVE
This case illustrates the importance of the costosternal complex in maintaining the stability and alignment of the thoracic spine. The patient was iatrogenically destabilized by placement of a pectus bar leading to rapid symptomatic progression of his Scheuermann's kyphosis, ultimately requiring surgical correction.
SUMMARY OF BACKGROUND DATA
Scheuermann's kyphosis is a disease process defined by strict radiographical and clinical criteria. Surgical treatment is generally recommended for curves greater than 75°. This case demonstrates the critical role of the costosternal complex in maintaining the stability of the thoracic spine. The patient described in this report underwent placement of a pectus bar for correction of symptomatic pectus excavatum. He subsequently developed a progressive symptomatic Scheuermann's kyphosis as a result of the destabilization of his costosternal complex. This patient ultimately required removal of the pectus bar and posterior instrumented kyphosis correction.
METHODS
Progressive symptomatic Scheuermann's kyphosis (105°) corrected by removal of the pectus bar, T11 posterior vertebral-column resection and T4-L3 instrumented posterior spinal fusion.
RESULTS
The patient had an uneventful immediate postoperative course. He was discharged neurologically intact with dramatic kyphosis correction and significant symptomatic improvement. Radiographs obtained 3 years postoperatively reveal stable thoracolumbar correction.
CONCLUSION
The costosternal complex plays a critically important role in the intrinsic stability of the thoracic spine. Iatrogenic disruption of the costosternal complex can result in rapid progression of thoracic/thoracolumbar kyphosis in the setting of Scheuermann's disease.
Topics: Adolescent; Biomechanical Phenomena; Device Removal; Disease Progression; Funnel Chest; Humans; Iatrogenic Disease; Magnetic Resonance Imaging; Male; Orthopedic Procedures; Radiography; Range of Motion, Articular; Reoperation; Scheuermann Disease; Spinal Fusion; Thoracic Vertebrae; Time Factors; Treatment Outcome
PubMed: 23202355
DOI: 10.1097/BRS.0b013e31827fc5cb -
Therapeutische Umschau. Revue... Oct 1987
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Studies in Health Technology and... 2002For the follow-up of patients with sagittal spinal deformities and postural disorders, we do not have well validated measuring systems at our disposal. All clinical... (Review)
Review
For the follow-up of patients with sagittal spinal deformities and postural disorders, we do not have well validated measuring systems at our disposal. All clinical measuring parameters are liable to a high margin of error. With a growing number of patients suffering from postural disorders and kyphoses, we have to look for other possibilities to monitor changes of the back, as well as in the short term, without the support of X-rays. As the measuring of the surface with the Formetric system showed a high measurement reliability in previous studies, we used this system to demonstrate the rehabilitation results of our patients with Scheuermann's disease. An intervention study (pre-/post-design) was undertaken including the following material.: 62 female patients with Scheuermann's disease and an average age of 19 years old and 74 male patients with Scheuermann's disease and an average age of 20 years old were measured with the Formetric system before an in-patient rehabilitation of four to six weeks. For this study, we evaluated the maximal kyphotic angle as shown by the system. In the case of female patients, the maximal kyphotic angle decreased highly significantly from sixty two to nearly fifty four degrees. In the case of the male patients, it decreased from sixty to nearly fifty five degrees at the end. It showed that the surface measuring system with the Formetric System is a reliable instrument for the follow-up of sagittal postural disorders and kyphoses for the present study, especially in the case of Scheuermann's disease. In praxis, the use of this measurement is very easy, we obtain the measurement results very quickly, so that the evaluation of data is not very time consuming. After the in patient treatment, the kyphotic angle decreased highly significantly. The changes range far above the margin of error, thus the following conclusions are justified. Firstly, the Formetric System is the appropriated instrument for the follow-up of postural disorder and kyphoses. Secondly, the in-patient rehabilitation with an intensive treatment program may result in a correction of also structural kyphoses with sure signs of Scheuermann's disease. Thus we recommend an in-patient rehabilitation in adolescent age in case of Scheuermann kyphoses with large curvatures and in case of Scheuermann kyphoses in adults suffering from pain.
Topics: Humans; Image Processing, Computer-Assisted; Inpatients; Scheuermann Disease; Treatment Outcome
PubMed: 15456043
DOI: No ID Found