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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 78

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 78. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Spinal Deformities and Malformations Section 765 28 Juvenile Kyphosis Scheuermann s Disease Dietrich Schlenzka Vincent Arlet Core Messages Scheuermann s disease Type I classic Scheuermann s is a thoracic or thoracolumbar hyperkyphosis due to wedged vertebrae developing during adolescence Atypical Scheuermann s disease Type II lumbar Scheuermann s affects the lumbar spine and or the thoracolumbar junction. It is a growth disturbance of the vertebral bodies without significant wedging causing loss of lumbar lordosis or mild kyphosis The natural history of the deformity is benign in the majority of cases Back pain is common but usually mild and rarely interferes with daily activities or professional career Lung function is impaired only in very severe deformities 100 degrees Diagnosis is based on the clinical picture and typical changes in plain lateral radiographs During growth brace treatment is recommended in mobile deformities of between 45 and 60 degrees Rare spinal cord compression is the only absolute indication for operation Relative indications for operation are kyphosis greater than 70 degrees pain and cosmetic impairment The results of operative treatment are satisfactory in the majority of cases regarding pain and cosmesis The risk of severe intra- and postoperative complications should be weighed carefully against the benefits Epidemiology Scheuermann s disease is a thoracic or thoracolumbar hyperkyphosis due to wedged vertebrae developing during adolescence. Ancient presentations of hyperkyphosis usually depict extreme gibbus formations as seen due to infection tuberculosis or congenital vertebral anomalies. Michelangelo s ceiling fresco in the Sistine Chapel at the Vatican shows an ignudo with a kyphosis resembling a thoracolumbar juvenile kyphosis Fig. 1 . It was painted in 1511 and is possibly the earliest pictorial representation of the disease 30 . Following Schanz Haglund named the deformity Lehrlingskyphose apprentice s kyphosis as it was detected