Kyphosis: Thoracic kyphosis > 45° with more than 5° of anterior wedging in 3 consecutive vertebrae.
Aetiology
Developmental error of collagen leading to disturbed endochondral ossification of the vertebral end plates, resulting in wedge-shaped vertebrae and kyphotic deformity.
Commonly affects the thoracic spine, though it may also involve the lumbar region.
Thoracolumbar junction is usually spared.
Lumbar Scheuermann’s: Similar features but no vertebral wedging, more likely to be symptomatic.
Clinical Presentation
Age group: Typically affects adolescent boys.
Symptoms:
Poor posture.
Pain over the deformity.
Rare neurologic compromise.
Kyphosis does not correct with hyperextension.
Imaging Features
Wedge-shaped vertebrae.
Irregular end plates.
Kyphosis with gibbus: Acute angular kyphosis.
Schmorl’s nodes: Protrusion of cartilage from the disc through the end plate into the vertebra.
Management
Non-Operative:
Bracing: Recommended if near skeletal maturity and pain is not a major issue.
Operative:
Indications for surgery:
Kyphosis >75°.
Progressive kyphosis in younger children.
Significant back pain.
Neurologic deficit (rare).
Cosmesis: Relative indication for surgery.
Surgical Procedure:
Posterior Instrumented Fusion.
Multiple wedge osteotomies (Smith-Peterson) may be needed.
Anterior release only required if curve >90°.
Decompression of neurologic structures if deficit is present (rare).
Complications
Junctional Kyphosis.
Neurologic injury: Uncommon, but requires attention during surgery.