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Figure 1: The right image shows a
of the wedged vertebrae
Hyper-kyphosis [forward bend of the thoracic (ribbed) vertebrae beyond normal limits] is classified as either postural or structural in origin. Postural kyphosis will correct when the patient is asked to stand up straight. Patients with postural kyphosis have no abnormalities in the shape of the vertebrae. Scheuremann’s kyphosis is defined as rigid (structural) kyphosis because the front sections of the vertebrae grow slower than the back sections. This results in wedge-shaped vertebrae rather than rectangular shaped vertebrae that line up well (Figure 1 and 2)
. This process occurs during a period of rapid bone growth, usually between the ages of 12 and 15 years of age in males, or a few years earlier in females. The abnormal kyphosis is best viewed from the side in the forward-bending position where a sharp, angular abnormal kyphosis is clearly visible.
Lateral x-ray of a patient with
disease. Close-up x-ray demonstrating
characteristic of Scheuremann's
Patients with Scheuremann's disease often present with poor posture and complaints of back pain. Back pain is most common during the early teenage years and in most instances will decrease as they approach adulthood. The pain rarely interferes with daily activity or professional careers. The kyphosis is more likely to be symptomatic if the apex (most angular section) is in the mid-to-low back instead of upper back. In severe cases, adolescents may not be able to lie on their back without several pillows under their head.
The kyphotic deformity that develops with growth frequently remains mild and requires only periodic X-rays.