Surgery is rarely needed for Scheuermann’s disease, and nonsurgical options will typically be attempted before surgery is considered.
There are certain situations in which surgery may be advised, however. It may be considered for patients with severe deformities—such as a curvature of more than 75 degrees for thoracic kyphosis, if neurological deficits are present, and occasionally if pain is caused by the deformity.
The goal of the surgery is mainly to reduce the deformity, and possibly lessen pain or neurological symptoms. Surgery will typically include:
- A front thoracotomy (approach through the chest) to release the tissues, remove the discs, and place a bone graft in the spaces to fuse the thoracic spine
- During the same surgery, the spine is then approached from the back and instrumentation, such as rods, bars, wires, or screws, to hold the spine straight during the fusion process is put in place.
After surgery, provided the fusion is successful, all the affected segments will be fused into one continuous bone that will not progress into excessive curvature, or kyphosis. Because Scheuermann’s disease usually occurs in the thoracic spine, which has almost no motion, a fusion in this area does not affect the normal motion of the spine and typically does not lead to pain later in life.
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Most of the motion in the spine is in the lumbar spine, and it is usually not necessary to fuse this area.
Scheuermann’s disease does not typically get worse once the individual has stopped growing. For adults with Scheuermann’s kyphosis, the treatment is usually observation, anti-inflammatory medications (such as NSAIDs). Reconstructive surgery may be considered if the symptoms are severe and disabling, however.