Kyphosis Case 3

Case Review #3: 17 year old male with Scheurmann's Kyphosis from Robert Pashman

A 17 year old male presented with progressive Schuermann’s Kyphosis. The patient had a 75° spinal curvature. Dr. Pashman treated the patient with a posterior fusion from T3 to L1.

    Case Review:

    Progressive Scheurmann’s Kyphosis

    Patient History:

    17 year old male, water polo player.Diagnosed with Scheuermanns Kyphosis, well documented with X-rays and MRI.Patient is neurologically intact.He was felt to have a mixed mesenchymal or connective tissue disease but undiagnosed and genetically untyped. The patient has no other comorbidities or other problems related to connective tissue disorders.Complains of severe neck pain and low back pain which is not being treated adequately with anti-inflammatory medicines.

    Pre-op X-rays:

    Hyperextension posterior bending revealed a fixed rigid saggital plane deformity necessitating multiple level spinal osteotomy for shortening and manipulation. This was in lieu of anterior release.

    Indications for Surgery:

    A 75° progressive Scheuermanns kyphosis, thoracicspine.Significant thoracic pain with compensatory lordotic neckand low back painFailed conservative therapy.Possible mixed mesenchymal connective tissue disorderadding to morbidity of progressive kyphosis.Compensatory cervical lordosis produces increasedfacet pressure and neuroforaminal stenosis – the likelycause of neck problems in patients with thoracickyphosis.

    Surgical Strategy:

    Segmental spinal instrumentation for correction of progressive Scheuermanns kyphosis, thoracic 3 to lumbar 1 using CDLegacy 1/4 inch stainless steel rod-screw construct.Multiple level spinal osteotomy Smith-Peterson/Ponte with radical facetectomy bilaterally, T4-5, 5-6, 6-7, 7-8, 8-9, 9-10and 11-12, a 7-level osteotomy for posterior release of rigidfixed Scheuermanns kyphosis, all under the microscope and loupes. Posterior spinal fusion thoracic 3 to lumbar 1 using locallyharvested autogenous bone and rhBMP. Subtotal laminectomy T4 to T12 for mobilization of ligamentum flavum and for posterior spinal shorteningthoracic spine, 7 level.Intraoperative SSEP and motor evoked potential interpretation.Intraoperative fluoroscopic interpretation and control.

    Post-Op Films:

    At the time of operation, a rigid Scheuermanns kyphosis was found. This necessitated multiple level osteotomy for mobilization, which was ultimately achieved to bring the patient back into sagittal balance and normal thoracic alignment.

    Pre-Op/Post-op Comparison:

    X-rays look good with normal alignment and excellent cosmetic outcome. At six months post-op the patient was exercising, including weight lifting, swimming, and cardio.