Preoperative Scheuermann’s kyphosis work-up needs to include lateral radiograph, precise neurological exam

NEW ORLEANS — There is a place for nonoperative treatment of Scheuermann’s kyphosis in patients whose spine curves are smaller and only reach 70° to 75°, but it is diminishing in favor of surgical treatment, according to a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting, here.

Bracing and casting associated with conservative care of these patients has fallen out of favor with orthopedic surgeons, even though in a recent study it was shown to be successful, B. Stephens Richards III, MD, said during a symposium on the management of sagittal imbalance in these patients.

Richards discussed nonoperative and operative treatments for Scheuermann’s kyphosis, as well as the key considerations for diagnosing the condition

B. Stephens Richards III

“Don’t give up on the nonoperative approach,” he said. “It remains a viable option, though for a minority of patients.”

“More commonly the operative approach is used and the indications include rigid deformity that exceeds 70° to 75°, an unacceptable appearance and, unquestionably, persistent pain. Our goals are to obtain a well-balanced sagittal appearance, preserve normal neurological function and avoid a junctional kyphosis,” he said.

He emphasized the need for a precise neurological exam and getting a lateral radiograph preoperatively, and not necessarily an MRI.

“An MRI is debatable in Scheuermann’s kyphosis,” according to Richards, who went on to review the role that preoperative planning, intraoperative neuromonitoring, anterior releases, osteotomies and cantilevering methods can play in successful operative outcomes.

“Curves exceeding 70° with strong cosmetic concerns qualify for operative treatment. MRI is not a routine requirement and posterior compression techniques provide excellent correction without the need for anterior releases,” Richards said. – by Susan M. Rapp

Reference:

Richards BS. Scheuermann’s kyphosis & roundback: Diagnosis & current treatment guidelines. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

Disclosure: Stephens has stock or stock options with Pfizer and receives royalties, financial or material support from Wolters Kluwer Health-Lippincott Williams & Wilkins.