Question:Our son has been treated with serial casting and now a body brace for Scheuermann's deformity. The curve continues to get worse. We've been told that surgery is the next step. How do we know when the best time is for surgery? Is it possible to wait too long? Operate too soon?
Answer:Scheuermann's kyphosis is the name given to a condition of increased rounding of the thoracic spine. Structural deformity of the vertebral bones is involved. As the spine curves forward, the front part of the vertebrae become wedge-shaped.
Other changes may also occur. The cartilage around the discs can get pushed up into the end-plate of the vertebral body. There is a distinctive change seen on X-rays to suggest when this has happened.
The protrusion of the cartilage may contact the marrow of the vertebra. If this happens, inflammation and even destruction of the vertebral bone may occur. Surgery may be advised to avoid this complication.
An anterior release and fusion (a two-step operation) is the usual procedure performed. The timing of the surgery is decided on a case-by-case basis. Anyone with pain and a rigid spine that is curved forward 70 degrees or more is usually a good candidate.
If the deformity is getting worse even with casting and/or bracing, then surgery is the next step. An unacceptable cosmetic appearance is also considered in the decision-making process.
Your surgeon will be able to give you the best timeline to consider. X-rays and MRIs are often used along with the history of the case to determine the optimal timing for surgical intervention.Amy L. McIntosh, MD, and Daniel J. Sucato. Scheuermann's Kyphosis. In Current Opinion in Orthopaedics. November 2007. Vol. 18. No. 6. Pp. 536-543.
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