PURPOSE: To describe the MR imaging findings of lumbar Scheuermann's disease and to determine therelationship between various MR imaging findings of this disease and disk pathologies. MATERIALS AND METHODS: Weretrospectively evaluated the MR imaging findings of 13 patients under the age of 20 with lumbar Scheuermann'sdisease. One hundred and four vertebral bodies and 91 intervertebral disks were included in the study. The imagingfindings were analyzed with particular emphasis on the wedging of vertebral bodies, Schmorl's nodes, and theheight of intervertebral disks. The relationship between these findings and disk degeneration or herniation wasevaluated. RESULTS: Lumbar Scheuermann's disease was classified into two types according to Blumenthal'sclassification. Seven patients were type I and six were type II. Disk degeneration and herniation were identifiedin 28.6% (26/91) and 20.9% (19/91), respectively, of intervertebral disks. In type I, wedging of the vertebralbodies was noted in 48.2% of cases(27/56) and degeneration and herniation of adjacent disks were identified in24.1% (7/29) and 13.8% (4/29), respectively. Central Schmorl's nodes were identified in 29.5% (33/112) ofend-plates and degeneration and herniation of adjacent disks in 34.8% (8/23) and 17.4% (4/23), respectively. Intype II, anterior Schmorl's nodes were found in 11.5% (11/96) of end-plates and degeneration and herniation ofadjacent disks in 100% (10/10) and 70% (7/10), respectively. Decreased height of intervertebral disks was notedadjacent to the anterior Schmorl's nodes ; all were related to disk degeneration and 70% (7/10) to diskherniation. There was statistically significant correlation between anterior Schmorl's node, decreased height ofintervertebral disk and adjacent disk pathologies (p<0.05), but wedged vertebra and central Schmorl's node werenot related to disk pathologies (p>0.05). CONCLUSION: In lumbar Scheuermann's disease, anterior Schmorl's nodeand decreased height of an intervertebral disk are related to disk degeneration and herniation. MR is useful forthe evaluation of disk pathologies as well as changes in vertebral bodies.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging* ; Pathology* ; Scheuermann Disease* ; Spine

STUDY DESIGN: In this prospective study, we measured the pad pressures of the Milwaukee brace in adolescent hyperkyphosis treatment. PURPOSE: We evaluated the skin-brace interface forces exerted by the main pads of the Milwaukee brace. OVERVIEW OF LITERATURE: A fundamental factor associated with brace effectiveness in spinal deformity is pad force adjustment. However, few studies have evaluated the in-brace force magnitude and its effect on curve correction. METHODS: Interface forces at four pads of the Milwaukee brace were measured in 73 patients withround back deformity (mean age, 14.04±1.97 years [range, 10–18]; mean initial Cobb angle,67.70°±9.23° [range, 50°–86°]). We used a modified aneroid sphygmomanometer to measure the shoulder and kyphosis pad pressures. Each patient underwent measurement in the standing and sitting positions during inhalation/exhalation. RESULTS: The mean pad pressures were significantly higher in the standing than in thesitting position, and significantly higher pressures were observed during inhalation compared toexhalation (p=0.001).There were no statistically significant differences between right and left shoulder pad pressures (p>0.05); however, the pressure differences between the right and left kyphosis pads were statistically significant (p<0.05). In a comparison of corrective forces with bracing for less or more than 6 months, corrective force was larger with bracing for less than 6 months (p=0.02). In the standing position, there were no statistically significant correlations between pad pressures and kyphosis curve correction. CONCLUSIONS: In the sitting position, there was a trend toward lower forces at the skin-brace interface; therefore, brace adjustment in the standing position may be useful and more effective. There was no significant correlation between the magnitude of the pad pressures and the degree of in-brace curve correction.
Adolescent* ; Braces* ; Congenital Abnormalities* ; Humans ; Inhalation ; Kyphosis ; Posture ; Prospective Studies ; Scheuermann Disease ; Shoulder ; Sphygmomanometers

Morphologically, kyphosis is devided into two groups, pure kyphosis and kyphoscoliosis, according to whether or not scoiiosis is combined. Or kyphosis can be devided into round kyphosis or angular kyphosis. The examples of round kyphosis are Scheuermanns kyphosis or ankylosing spondylitis. Acute angular kyphosis are of congenital kyphosis or old healed tuberculosis. The purpose of surgical correction of fixed kyphosis is to correct deformity as well as to prevent or to recover from paraplegia. The operation also improve respiratory and digestive function by diminishing compression of abdomen. However, the correction of this deformity is more dangerous in eliciting paraplegia than any other spinal deformity. In considering surgical correction of kyphosis we have to decide which approach is the best for that particular patient at that particular time. Usually majority of patient need combined anterior and posterior approach. The extent of fusion depends upon the flexibility of the kyphosis. Anterior fusion should encompass at least the rigid and inflexible portion of the kyphosis as determined by the hyperextension x-ray of the spine. Posterior fusion should encompass the full extent of the kyphosis. The purpose of this study is to report our results for surgical correction and to find the operative procedure which shows the best result. We hereby report surgically corrected 14 cases of fixed kyphosis who were hospitalized here from April 1988 to February 1995.
Abdomen ; Congenital Abnormalities ; Humans ; Kyphosis* ; Paraplegia ; Pliability ; Scheuermann Disease ; Spine ; Spondylitis, Ankylosing ; Surgical Procedures, Operative ; Tuberculosis

STUDY DESIGN: Retrospective study (level of evidence: level 3). PURPOSE: The purpose of this study was to evaluate the clinical and radiological results of the posterior-only approach with pedicle screws for the treatment of Scheuermann's kyphosis (SK). OVERVIEW OF LITERATURE: The correction of SK with instrumentation can be performed using posterior-only or combined anterior-posterior procedures. With the use of all-pedicle screw constructs in spine surgery, the posterior-only approach has become a popular option for the definitive treatment of SK. In a nationwide study involving 2,796 patients, a trend toward posterior-only fusion with lower complication rates was reported. METHODS: We retrospectively reviewed the data of patients who underwent posterior-only correction for SK between January 2005 and May 2013. Patients with a definite diagnosis of SK who fulfilled the minimum follow-up criterion of 24 months were included. The thoracic kyphosis (T5–T12), lumbar lordosis (L1–S1), and thoracolumbar junction (T10–L2) angles were measured from preoperative, postoperative, and last control radiographs. Sagittal balance, thoracic length, thoracic diameter, Voutsinas index and the sacral slope, pelvic tilt, proximal junction kyphosis, and distal junction kyphosis angles were also measured. RESULTS: Forty-five patients underwent surgery for the treatment of SK between 2005 and 2013. After applying the exclusion criteria, 20 patients (18 males and 2 females) with a mean age of 19 years were included. The mean thoracic kyphosis angle was 79.8 degrees preoperatively, 44.6 degrees postoperatively, and 44.9 degrees at the last control. There were statistically significant differences between preoperative and postoperative values in the thoracic kyphosis and lumbar lordosis angles, thoracic length, thoracic diameter, and Voutsinas index (p<0.05). CONCLUSIONS: The clinical and radiological results of the current study suggest that posterior-only fusion is an efficient technique for the treatment of SK.
Animals ; Diagnosis ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Male ; Pedicle Screws* ; Retrospective Studies ; Scheuermann Disease* ; Spinal Fusion ; Spine

BACKGROUNDScheuermann's disease (SD) is a spinal disorder and includes both a classic form and an atypical form. Interestingly, its existence among the general population as well as the disc disease patients is common. One of our previous studies showed that about 18% of the hospital staff members meet the SD criteria. On the other hand, another study has demonstrated that 95.2% of the symptomatic thoracolumbar disc herniation (STLDH) patients meet the SD criteria, which suggests that STLDH is very likely a special form of SD. The purpose of this study was to discriminate the factors contributing to the development of STLDH by comparing STLDH patients with the healthy SD-like hospital staff members.

METHODSThis is a retrospective study including 33 STLDH patients who met the SD criteria and 30 SD-like hospital staff members. The STLDH group was chosen from a group of patients who underwent surgery after a diagnosis of STLDH (T10/11-L1/2) at our hospital between June 2007 and June 2010. SD-like hospital staff members were chosen from a database created in 2007, which contained a lumbar MR and low back pain (LBP) questionnaire of 188 hospital staff members. The demographic and radiologic characteristics were compared between groups.

RESULTSThere was no statistical difference in sex, age, and height between the two groups. The STLDH patients had higher body weight, boby mass index, and thoracolumbar kyphotic angle than SD-like hospital staff members. In addition, STLDH patients had more levels of Schmorl's nodes (3.5±1.7 vs. 2.0±1.9, t = 3.364, P = 0.001) and irregular endplateson (4.0±1.9 vs. 2.7±1.9, t = 2.667, P = 0.010) compared to the SD-like hospital staff members.

CONCLUSIONSHigher body weight, higher body mass index, larger thoracolumbar kyphosis, and more Schmorl's nodes and irregular endplates on MR may be associated with the development of STLDH in "SD-like people."

Adult ; Female ; Healthy Volunteers ; Humans ; Intervertebral Disc Displacement ; diagnostic imaging ; Middle Aged ; Radiography ; Retrospective Studies ; Scheuermann Disease ; diagnostic imaging ; Thoracic Vertebrae ; diagnostic imaging ; pathology

STUDY DESIGN: Randomized controlled single-blinded clinical trial. PURPOSE: To evaluate the efficacy of Schroth therapy on thoracic curve angle, pain, and self-perceived body image (SPBI) of the back in Scheuermann's patients in comparison with the efficacy of classic anti-gravitation exercises. OVERVIEW OF LITERATURE: Scheuermann disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine during adolescence. However, very few studies evaluated the effect of exercises on the progression of kyphosis in Scheuermann patients. Schroth three-dimensional exercise therapy was found in several studies to be effective in the treatment of adolescent scoliosis; however, we found no randomized controlled trials that evaluated the efficacy of this method in Scheuermann patients. METHODS: A total of 50 young adults (males and females) with Scheuermann's disease were randomly divided into either the experimental group (Schroth therapy treatment, n=25) or the control group (classic anti-gravitation exercises, n=25). Participants in both the groups were provided a course of individual treatment sessions during few weeks, with one appointment per week. They were required to perform the exercises daily throughout the study period (12 months) and fill their performance in a research log. We evaluated the thoracic Cobb angle (main outcome measure), pain, SPBI, flexion of the shoulder (supine), flexion of the shoulder (standing), kyphotic deformity measured using inclinometer, and L5 kyphosis apex line (L5-KAL) as well as administered the Scoliosis Research Society-22 Questionnaire for the participants before the treatment, after 6 months, and 1 year postoperatively. These results were then compared. RESULTS: In the mixed analysis of variance, the main effect of time was significant in the thoracic kyphosis (F [1]=5.72, p=0.02), and in the L5-KAL (F [1]=5.76, p=0.02). The main effect of time on the kyphotic deformity, measured using an inclinometer, did not reach the significance level; however, it showed the tendency (F [1]=2.80, p=0.07). In the group-by-time interaction, a significant difference was found in the thoracic kyphosis (F [1]=4.91, p=0.03) and in the kyphotic deformity, measured using an inclinometer (F [1]=4.05, p=0.02). Thus, the Schroth therapy group showed significantly greater improvement than the classic anti-gravitation exercises group. CONCLUSIONS: The present findings indicate that back exercises in general, and Schroth therapy in particular, is an effective treatment for preventing and significantly improving the thoracic Cobb angle and symptomatic representation in Scheuermann's patients.
Adolescent ; Body Image ; Congenital Abnormalities ; Exercise ; Exercise Therapy ; Humans ; Kyphosis ; Methods ; Physical Therapy Modalities ; Posture ; Quality of Life ; Randomized Controlled Trials as Topic ; Scheuermann Disease ; Scoliosis ; Shoulder ; Spine ; Young Adult

OBJECTIVETo evaluate the effectiveness of combined thoracoscopic anterior spinal release and posterior correction for Scheuermann's kyphosis.

METHODSSixteen patients with a diagnosis of Scheuermann's kyphosis were selected to undergo thoracoscopic anterior spinal release, disc excision, and fusion in conjunction with instrumented posterior correction and spine fusion. Cobb angle of the kyphosis were measured before the operation and during the follow-up period to evaluate the correction. Pre- and post-operative Oswestry disability Index (ODI) were collected to evaluate the pain relief.

RESULTSAll 16 patients underwent successfully corrections. The mean preoperative kyphosis (Cobb) was 78.8 degrees (70 degrees-92 degrees), the mean postoperative kyphosis (Cobb) was 40.5 degrees (36 degrees-47 degrees), and the last follow-up evaluation of the kyphosis was 41.7 degrees (36 degrees-50 degrees ). All patients obtained satisfied pain relief. The mean preoperative ODI was 37.3 (0-72), and the mean postoperative ODI was 6.4 (0-30).

CONCLUSIONCombined thoracoscopic anterior spinal release and posterior correction is a good method for the treatment of Scheuermann's kyphosis.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; diagnostic imaging ; etiology ; surgery ; Male ; Radiography ; Scheuermann Disease ; complications ; diagnostic imaging ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; surgery ; Thoracoscopy ; Treatment Outcome