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Year |
2001 |
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Question Number |
238. |
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Category |
Select |
Question
A 13-year-old boy has nonrigid Scheuermann’s kyphosis. Weightbearing radiographs show a kyphosis of 70? from T7 to L1, with scoliosis that measures 10? at Risser 2 maturity. Management should consist of
1- postural exercises and analgesics
2- a Charleston bending brace
3- an extension-type spinal orthosis
4- posterior spinal fusion with instrumentation
5- anterior spinal release and posterior spinal instrumentation
Figures
Answer (click for answer)
Preferred response: 3
Treatment for Scheuermann’s kyphosis consists of bracing (a modified Milwaukee extension brace) for a progressive curve in a patient with 1 year or more of skeletal growth remaining (Risser stage 3 or below). Bracing may affect 5-10 degrees of permanent curve correction but is less effective for kyphosis >75 degrees. Surgical correction would be indicated for skeletally mature patient with severe kyphosis (>75 degrees). Posterior fusion with dual rods segmentally attached compression instrumentation is the treatment of choice, preceded by anterior release and interbody fusion for curves > 75 degrees or those that don’t correct to < 55 degrees on hyperextension. Postural exercises are indicated for postural round back (kyphosis which does not demonstrate vertebral body changes).
Reference: Lowe TG: Scheuermann disease. J Bone Joint Surg Am 1990;72:940-945.
Tribus CB: Scheuermann’s kyphosis in adolescents and adults: Diagnosis and Management. J Am Acad Orthop Surg 1998;6:36-43.