Question:We are just a little disappointed in the results of surgery our son had for Scheuermann's disease. At the time of the fusion, he was 16. Now at age 22, he has developed another curve above the fusion. What causes this to happen? Does it happen often?
Answer:Scheuermann's kyphosis is an excessive forward curvature of the thoracic spine. The thoracic spine is located midway between the neck and the lumbar spine (low back).
Scheuermann's kyphosis is an uncommon condition that begins in childhood. It affects less than one percent of the population. Boys and girls are affected equally. When it occurs, it is usually diagnosed by the time the child is 11 years old.
Proper treatment during childhood is needed to relieve back pain and prevent both pain and spinal deformity. If casting or bracing don't work, then surgery to fuse the spine may be required to halt the progression of this disease.
Surgery for this condition has improved over the years. Better surgical technique, improved tools, and up-to-date implants are part of the current picture. But even with advances in operative procedures, problems can occur.
One of those problems is called junctional kyphosis. This is the development of another kyphotic curve above or below the top or bottom of the fusion site. Surgeons aren't entirely sure what causes this to happen.
It's possible that the spine is trying to balance uneven forces or imbalances that are present next to the fusion. As the kyphosis is straightened, the unfused spine responds with its own changes. It appears that this compensation is influenced by the angle of the pelvis. Loss of ligamentous integrity on either side of the fused site may also be part of the problem.
Patients with large curves before surgery tend to develop junctional kyphosis at the top of the fused area. Although the new kyphosis may cause problems with cosmetic appearance, further surgery is rarely required.Baron S. Lonner, MD et al. Operative Management of Scheuermann's Kyphosis in 78 Patients. In Spine. November 15, 2007. Vol. 32. No. 24. Pp. 2644-2652.
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