General Editor: Luiz Vialle

Scheuermann Kyphosis

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Glossary

General considerations

The choice of the treatment will depend on the magnitude and flexibility of the curve.

Nonoperative procedure
Main indication Skill Equipment
Deformity of 40-70° in skeletally immature patients Basic surgical experience, no specialized skills Basic equipment only

Further indications

  • Very flexible curves in a skeletally immature patient, even curves above 70°
Posterior instrumentation without release
Main indication Skill Equipment
Curves up to 90° which corrects more than 50% in hyperextension films Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications

  • Thoracolumbar kyphosis above 50 degrees, usually associated with pain despite conservative management
  • Failure of conservative treatment to arrest deformity progression
  • Cosmetic deformity that is unacceptable to the patient and his family
  • Sharp and angular deformity
  • Pulmonary compromise (rare, unless curve greater than 100 degrees)
  • Neurologic deficit (usually due to associated conditions, such as a disc herniation or dural cysts)

Advantages

  • Shorter procedure with less risk of complications
Posterior instrumentation with release
Main indication Skill Equipment
Curves more than 90° or smaller curves which do not correct more than 50% in hyperextension films Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Patients with severe disk degeneration and anterior osteophytes would benefit from anterior release.

Indications

  • Thoracolumbar kyphosis above 50 degrees, usually associated with pain despite conservative management;
  • Failure of conservative treatment to arrest deformity progression;
  • Cosmetic deformity that is unacceptable to the patient and his family;
  • Sharp and angular deformity;
  • Neurologic deficit (usually due to associated conditions, such as a disc herniation or dural cysts).

Advantages of anterior release

  • Increased correction of the deformity
  • Less stress on the posterior implants
  • Graft is placed in the intervertebral space increasing fusion rates

Disadvantages of anterior release

  • Lengthier procedure
  • Need for chest tube postoperatively
  • Risk of lung and vascular injury

Advantages of osteotomies

  • Increased correction of the deformity
  • Less stress on the posterior implants
  • May eliminate the need of anterior release

Disadvantages of osteotomies

  • Higher neurological risk
  • Higher nonunion risk
  • Increased blood loss
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2016-12-01