Scheuermann's kyphosis: diagnosis, presentation and treatment

Scheuermann's disease is a rigid kyphotic deformity due to anterior wedging of at least three thoracic vertebrae that occurs in the growing spine. The aetiology, pathogenesis and natural history are not completely understood and this leads to significant debate about the treatment options. Patients present with a cosmetic deformity and thoracic pain but symptoms tend to settle at skeletal maturity. For most patients, observation and physiotherapy alone are required during spinal growth. In moderate deformities bracing may stop or slow down kyphosis progression whilst the spine grows but deformity tends to recur once the brace is removed. Surgical correction is indicated for adolescents with progressive deformities greater than 70° that are associated with thoracic pain and have not responded to nonoperative treatment. There is no consensus over optimal surgical technique for correction but options include posterior only or anteroposterior correction and spinal fusion, with or without posterior osteotomies to shorten the posterior column during correction. The risk of complications is significant and should be discussed in detail with the patient and their family prior to any treatment decision.