Scheuermann’s Disease

Definition

  • Juvenile rigid kyphosis
  • Structural thoracic or thoracolumbar kyphosis
  • Endplate growth disturbance causes anterior vertebral wedging

Epidemiology

  • Presents in adolescence, around 10 to 15 years
  • One of the most common causes of structural kyphosis at this age
  • Male predominance in many series
  • Familial tendency

Aetiology

  • Cause unknown
  • Proposed factors are genetic predisposition, mechanical loading, endplate osteoporosis and disordered ossification of the ring apophysis

Classification

  • Typical (thoracic), apex mid thoracic
  • Atypical (thoracolumbar or lumbar), more often painful, associated with heavy physical activity

Clinical Features

  • Round back deformity, often noticed by parents
  • Aching thoracic pain worse with activity
  • Rigid kyphosis not correcting on prone hyperextension, distinguishing it from postural kyphosis
  • Sharp angular deformity on forward bending
  • Compensatory lumbar and cervical hyperlordosis
  • Hamstring tightness and increased rate of spondylolysis
  • Neurology rare, from thoracic disc herniation or epidural cyst

Investigations

Scheuermann's Disease, imaging of scheuermann kyphosis from t6 to t10
Imaging of Scheuermann kyphosis from T6 to T10. Image by James Heilman, MD, Wikimedia Commons, CC BY-SA 4.0.
  • Sorensen criteria, anterior wedging of 5° or more in at least three adjacent vertebrae
  • Thoracic kyphosis above about 45°
  • Schmorl nodes, endplate irregularity and disc space narrowing
  • Mild scoliosis in some
  • Hyperextension lateral over a bolster assesses flexibility
  • MRI for neurological deficit and before surgery

Management

  • Observation and physiotherapy for mild curves and pain
  • Brace skeletally immature curves of about 50° to 75° in a Milwaukee brace or modified TLSO until maturity
  • Bracing is less effective for rigid or large curves and after maturity
  • Surgery for thoracic kyphosis over about 75° or thoracolumbar over about 65° with progression, pain, deformity or neurology
  • Posterior fusion with segmental pedicle screws and Ponte osteotomies
  • Add anterior release for very large rigid curves
  • Fuse from the proximal end vertebra to the sagittal stable vertebra to reduce junctional kyphosis
  • Avoid overcorrection, which increases proximal junctional kyphosis

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.