Scheuermann's kyphosis Flashcards Preview

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Flashcards in Scheuermann's kyphosis Deck (16):
1

What is Scheuermann's kyphosis defined as?

  • A RIGID THORACIC HYPERKYPHOSIS OF > 45 degrees

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2

What is the kyphosis caused by?

  • Anterior wedging of >5 degrees across 3 consecutive vertebra

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3

How is it differentiated from postural kyphosis?

  • Rigidity of the spine

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4

What is its epidemiology?

  • 1-8%
  • Most Common type of STRUCTURAL KYPHOSIS in ADOLESCENTS
  • M 2:1 F
  • location
    • Thoracic spine
    • less common forms occurs in thoracolumbar/lumbar region

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5

What is it pathology? What is its inheritance pattern ?

  • Exactly unknown
  • AUTOSOMAL DOMINANT

6

What are the associated condition?

  • HYPERLORDOSIS
  • SPONDYLOLYSIS 30-50%
  • SCIOLOSIS 3%

7

What is its prognosis?

  • Back pain in adults that very rarely limits ADLs ( mild curve mean 71o
  • Curves >75 degrees are likely to cause severe thoracic pain

8

what is the classification of scheuermann's kyphosis?

  • Thoracic Scheuermann's kyphosis
    • most common form
  • Thoracolumbar Scheuermann's kyphosis
    • less common
    • assoc w increased back pain
    • more irregular end-plates noted on xray
    • no vertebral wedging involved

9

what is the pt main complaint?

  • thoracic/ lumbar
    • pain
    • cosmesis

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10

what do you find on examination?

  • Thoracic kyphosis that does not correct with HYPEREXTENSION-
  • forward flexion- sharp bend in spine cf postural which is smooth, symmetrical see pic
  • normal thoracic kyphosis is 20-40 degrees
  • compensatory hyperlordosis cervical /lumbar spine
  • tight hamstrings

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11

what are the classic X-ray findings?

  • Anterior wedging across 3 consecutive vertebra
  • disc narrowing
  • endplate irregularities
  • SCHMORL's NODES- HERNIATION OF DISC into VERTEBRAL ENDPLATE
  • Scoliosis compensatory hyperlordosis look for spondylolsis on lumbar films
  • hyperextension lateral xray film- scheuermann's kyphosis remains inflexible

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12

What is the use of MRI in this condition ?

  • Determines any disc hernitation, epidural cysts, spinal stenosis 
  • show vertebral wedging, dehydrate disc, Schmorl's nodes- see mri scan

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13

What does tx involve ?

Non operative

  • Observe
    • KYPHOSIS <60 degrees & asymptomatic
    • most fall into this group
  • Bracing with extension type orthosis
    • ​CTLSO modified Milwalkee- see pic
    • Kyphosis 60-80o in pt Reisser 3 or less
    • with poor pt compliance
    • stop progression not lead to correction

Surgery

  • POSTERIOR SPINAL FUSION W DUAL ROD INSTRUMENTATION+/- ANT RELEASE AND INTERBODY FUSION
    • for Kyphosis >750 rigid, in skeletal mature pt
    • Neuro deficit/ spinal cord compression
    • severe pain in adults
  • - use of pedicle screw post are often sufficient and use of ant procedure is reducing

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14

What are the outcomes of surgery?

  • 60-90% reduction in pain with surgery
  • no correlation with amount of correction

15

describe the surgical technique?

  • PSF w DUAL rod instrumentation
  • Post midline to thoracic spine
  • Arthrodesis- include entire kyphotic cobb angle and stop distally to include 1st lordotic disc.
  • posterior bone grafting form iliac crest recommended to enhance fusion
  • Fixation - combo of hooks and pedicle screws
    • hooks maybe dangerous at apex of curve as potentially compress spinal cord
  • Correcting technique
    • insitu bending
    • goal to obtain final kyphosis of 45-50 degrees

Anterior release and interbody fusion- thorascopic anterior discectomy and interbody fusion have decreased morbidity of thoracotomy

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16

What are the complications ?

  • Neurological
    • higher than idiopathic scoliosis corrective surgeries
    • must monitor motor and sensory evoked potentials
  • Junctional kyphosis
    • occurs in 20-30% pts
    • avoid by making proper selection of fusion levels
    • avoid overcorrection - shouldn't exceed 50% original curve