Scheuermann's kyphosis

PURPOSE OF REVIEW: Scheuermann's kyphosis is a condition characterized by increased posterior rounding of the thoracic spine in association with structural deformity of the vertebral elements. Currently, there is debate over whether anterior procedures are necessary in the surgical treatment of Scheuermann's kyphosis. RECENT FINDINGS: Nonoperative treatment is reserved for skeletal immature patients (Risser 2 or less) with a progressive deformity that is cosmetically or functionally unacceptable. Surgical indications for Scheuermann's kyphosis should be assessed on a case-by-case basis, but in general patients with pain, a rigid deformity, a curve of more than 70-75°, progressive deformity and an unacceptable cosmetic appearance are surgical candidates. Newer technologies, such as third generation segmental instrumentation, in combination with compression rod techniques have nearly eliminated the need for combined anterior-posterior procedures. When an anterior procedure is deemed to be necessary, prone video-assisted thoracic surgery anterior release and fusion is an attractive alternative to formal open anterior release to provide the anterior release, followed by posterior correction and then placement of structural graft. SUMMARY: Combined anterior-posterior procedures are rarely necessary with current spine instrumentation and techniques. Proper fusion level selection, avoidance of adjacent posterior ligamentous tension band resection, and preventing overcorrection will limit junctional kyphosis.