What Is the Treatment of Scheuermann's Kyphosis in a Skeletally Mature Patient?
Clinical Scenario
Scheuermann's kyphosis (SK) in the skeletally mature patient poses a distinct management challenge. Once skeletal maturity is reached, the vertebral remodeling that bracing can achieve in younger patients is no longer available. Progressive deformity refractory to conservative measures, worsening pain, neurologic deficit, and significant structural deformity are recognised indications for surgical management in this population.
Treatment Approach (Partial Overview)
The operative strategy for this scenario is a posterior spinal fusion approach. Advances in thoracic instrumentation and corrective osteotomy techniques now allow meaningful sagittal realignment to be achieved through a posterior-only procedure.
The complete operative technique, specific instrumentation, osteotomy selection, and surgical algorithm are contained in the full protocol.
Correction Goals
The target is a correction of 40 to 50 degrees, or within 50% of preoperative kyphosis — sufficient to achieve adequate deformity correction while specifically avoiding junctional kyphosis.
References
DOI: 10.1007/s12178-023-09861-z
- Progressive deformity refractory to bracing, worsening pain, neurologic deficit, and significant deformity in skeletally mature patients are common indications for surgical management.
- 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.
- 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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