A skeletally immature patient with Scheuermann's kyphosis and a thoracic Cobb angle between 50° and 80°. Bracing in Scheuermann's kyphosis focuses on improving thoracic kyphosis with the goal of vertebral remodeling; there is a reproducible and overall successful result in patients with kyphosis between 50° and 80° when initiated before skeletal maturity. This protocol applies when that result has not been reached.
A formal exercise program emphasising thoracic extensor strengthening, abdominal strengthening, pectoralis stretching, and hamstring stretching — combined with a spinal orthosis (Milwaukee brace, thoracolumbosacral orthosis, or equivalent) worn at least 16 hours per day.
That line aimed to achieve approximately 50% initial correction of thoracic kyphosis with reduction in pain. When those targets are not met, this protocol is indicated.
The protocol involves operative management through a posterior-only spinal surgical approach, using multilevel corrective osteotomies across the apex of the deformity.
The clinical goal is a meaningful reduction in Cobb angle — within a defined target range — while specifically avoiding junctional kyphosis. The full technique, decision criteria, and complete algorithm are in the structured protocol.
DOI: 10.1007/s12178-023-09861-z
Skeletally immature patients with SK benefit from similar exercise programs, but require the addition of a spinal orthosis.
There is a reproducible and overall successful result in patients with kyphosis between 50 and 80° if initiated before skeletal maturity.
Bracing in SK focuses on improving thoracic kyphosis, with the goal of vertebral remodeling in skeletally immature patients.
More recently, however, the development of thoracic segmental pedicle screw instrumentation, combined with wide adoption of multilevel corrective osteotomies, now allow surgeons to achieve comparable sagittal correction through a posterior-only approach.
Multilevel posterior column osteotomies (Schwab type 2 or Ponte osteotomies) are used across the apex of the deformity.
A correction of 40 to 50°, or within 50% of preoperative kyphosis, is advisable to achieve adequate correction while avoiding junctional kyphosis.
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