What is Scheuermann’s Kyphosis?

Scheuermann’s kyphosis is a condition in which the front sections of the vertebrae, which are the small bones that make up the spine, grow more slowly than the back sections.

This difference in growth means the vertebrae grow into the shape of a wedge, when they should grow into the shape of a rectangle resulting in the bones developing a forward angle as it grows rather than stacking up in a straight line. This forward bend of the spine is called kyphosis.
This forward curve usually happens during a time when the bones are growing very quickly, often between the age 10 and 15, but for some patients it worsens when they are adults. The condition is thought to be quite rare, but the number of people affected is not truly known as often the condition is misdiagnosed and put down to poor posture. Scheuermann’s kyphosis affects both men and women in equal numbers.

Patients with Scheuermann’s kyphosis often have back pain, especially during the early teenage years but this pain usually decreases when a person gets closer to adulthood.

What has caused my Scheuermann’s kyphosis?

The cause of Scheuermann’s kyphosis is unknown. Research shows that there are probably a range of factors responsible but it is likely that it runs in some families.

How will my Scheuermann’s kyphosis be diagnosed?

Scheuermann’s kyphosis usually appears in adolescents when they are around 10-16 years old. Patients with Scheuermann’s kyphosis often have back pain, especially during the early teenage years.

Pain is also often the most noticeable symptom for adult patients but other signs are tightness of the chest (pectoral) muscles, hamstrings, which are the strong bands of tissue at the back of the thighs, and hip flexors, which are the inner hip muscles. About a third of people with Scheuermann’s kyphosis also have mild or moderate scoliosis. It can often take a while for Scheuermann’s kyphosis to be diagnosed because the symptoms can be attributed to poor posture.

What treatment will I receive?

The curve caused by Scheuermann’s kyphosis often stays mild and usually patients will only need X-rays to check that it is not getting bigger. Treatment may be needed if the size and progression, or worsening, of the curve is observed. The patient’s age, how much growing they have left to do, whether they are in pain, the effect of the curve on their appearance, and, in rare cases, the risk of cardiopulmonary (heart and lung) or neurological (nervous system) problems, are also taken into consideration when deciding the best course of treatment.

There is little information about what happens to the spine if no treatment is ever given for Scheuermann’s kyphosis. Many patients have no serious problems or disability and the symptoms settle once the spine is fully grown. However, people with severe kyphosis (a curve that is bigger than 80 degrees) can see their curve continue to get bigger, resulting in a large curve and severe back pain.

Bracing
If the curve is quite large (60-80 degrees) and the patient has not yet finished growing the most common course of treatment is for a back brace to be fitted. A back brace is made from a lightweight plastic and is worn full-time until the patient has finished growing, to try to reduce the risk of the curve getting bigger. The brace will be checked and adjusted regularly to ensure the fit is good and to improve results. To ensure the best results possible, the patient is usually asked to wear the brace for at least 18 months and sometimes longer.

An exercise programme is sometimes set to accompany the brace treatment, which helps the treatment to be even more effective. This programme includes exercises to strengthen the back and stomach muscles and stretch the hamstrings and chest muscles. On their own the exercises will probably help reduce back pain but will not stop the curve getting bigger.

Not all specialists agree that bracing works as a treatment, some say that there is a high risk a patient’s curve will continue to get bigger after they stop wearing the brace. Some specialists are concerned that wearing a brace as a teenager can cause distress and low self- esteem, your specialist will give you the advice you need to make the right decisions about treatments.

Surgery
Surgery may be advised if the curve continues to get bigger, to more than 70 degrees and causes pain, or is very noticeable. If a patient has a risk of a neurological issue (problem with the nervous system) an operation might also be offered. However, surgery will only be suggested if other treatments, such as bracing and physiotherapy, have been tried for 6 months but have not worked.

Modern surgical techniques allow for better correction of the kyphosis with often low complication rates and high patient satisfaction. It is important to note, however, that the operation to correct Scheuermann’s kyphosis can be difficult and sometimes the surgery can cause a major complication. These risks should be talked through, in detail, with the specialist team. Patients and their families need to weigh the risks against the difficulties caused by the curve and should carefully consider whether the benefits to the patient’s quality of life outweigh these risks.

Surgical complications are much more common in adults (21 in 100 people) than in adolescent patients (11 in 100 people).

How will Scheuermann’s Kyphosis affect my life?

Younger patients with Scheuermann’s kyphosis often have poor posture and back pain but this will usually decrease as the patient gets closer to adulthood. For most people the pain is rarely bad enough to affect daily activity or working life, however, those with bigger curves can have more severe pain that does not go away when they are adults. If the pain is bad patients should speak to their specialist about possible treatments. Contact our helpline on 020 8964 1166 for information about pain management.

If you need help or advice please call our Helpline on 020 8964 1166 or email info@ssr.org.uk.