What are the treatment options for Scheuermann's kyphosis?

Treatment Options for Scheuermann's Kyphosis

For adolescents with curves under 50° who are still growing, bracing is the primary treatment; for adults or those with severe curves over 75° causing persistent pain or neurologic problems, surgery is indicated, while physical therapy and anti-inflammatory medications serve as first-line management for pain in both groups. 1, 2

Conservative Treatment Approach

Physical Therapy and Medications

• Physical therapy combined with a short course of anti-inflammatory medications is the first-line treatment for adolescents presenting with pain 1
• For adults with pain, physical therapy, anti-inflammatory medications, and behavioral modification are the initial mainstays of treatment 1
• While physical therapy alone cannot alter the natural history of the disease, it remains the first choice before considering more aggressive interventions 2

Bracing for Adolescents

• Bracing is effective for controlling progressive curves in adolescent patients who are still growing 1
• Brace treatment (thoracic lumbosacral orthoses/TLSO) is most effective when diagnosis is made early, before the curve exceeds 50° 2
• Bracing should only be considered in skeletally immature patients with documented curve progression 1, 2

Important caveat: We cannot predict which curves will progress, making it difficult to determine the true effectiveness of bracing in preventing progression 2

Surgical Treatment Indications

When Surgery is Necessary

Surgery should be considered for patients meeting any of these criteria:

• Progressive deformity despite conservative treatment 1, 3
• Severe kyphosis exceeding 75° 2, 3
• Persistent, refractory pain unresponsive to conservative management 1, 3
• Neurologic deficit or compromise 1, 3
• Unacceptable cosmetic deformity significantly impacting quality of life 1, 3
• Cardiopulmonary compromise (rare) 3

Surgical Approaches

Posterior-only approach is safe and effective for severe rigid Scheuermann kyphosis, even in cases with curves of 85-105° 4

• Posterior-only surgery using advanced osteotomy techniques (Smith-Peterson osteotomy) and posterior release provides acceptable deformity correction with mean surgical time of 150 minutes and minimal blood loss (250ml average) 4, 5
• Combined anterior-posterior approaches are an alternative option 3
• Anterior-only approaches are less commonly used 3

Critical Surgical Principles

• Correction should not exceed 50% of the initial deformity to prevent complications 1, 3
• Instrumentation must extend beyond the end vertebral body to the first lordotic disk distally to prevent distal junctional kyphosis 1
• The entire length of the kyphosis must be included in the correction 3
• All sagittal balance parameters should be considered when planning surgery, not just the thoracic kyphosis angle 5

Surgical Outcomes and Complications

• Posterior-only approach in severe cases (mean preoperative angle 87.2°) achieved reduction to 47.4° postoperatively, with mean hospital stay of 3.5 days 4
• Most common postoperative complications are wound infection and loss of correction 3
• Hospital admission typically ranges 3-5 days for uncomplicated cases 4

Treatment Algorithm by Patient Age and Severity

For adolescents still growing:

• Curves <50° with pain → Physical therapy + NSAIDs
• Curves <50° with progression → Add bracing
• Curves >75° with pain/progression → Consider surgery

For adults or skeletally mature patients:

• Any curve with pain → Physical therapy + NSAIDs + behavioral modification
• Curves >75° with refractory pain → Surgery
• Any curve with neurologic deficit → Surgery regardless of angle 1, 5, 2, 3