FRCS Paediatric Ortho — improved notes
FRCS Paediatric Ortho — visual inline notes
← Previous
Slide 93 / 144
←/→ nav · S image · T theme · +/− font
Next →

093. Scheurmann kyphosis

visual-inline rebuild1 extracted figuresspeaker notes XML53 study lines4 Q&A

Individual slide images have been cropped from the rendered slide and inserted beside the matching note section. The full slide remains below only for layout/audit.

Clean FRCS notes with inline figures

Scheuermann's Kyphosis

Definition:

Sorensen criteria

•Rigid thoracic hyperkyphosis >45 deg (normal between 20 – 45 deg)
•Cause by anterior wedging of >5deg in 3 consecutive vertebrae
•Irregular endplate

Epidemiology:

•M > F
•AD inheritance, high penetrance with variable penetrance
•T > TL > L

Pathophysiology:

•Ring apophysis necrosis (occur at 12 yo)
•Cartilaginous endplate mechanical weakening

Pathology:

•Anatomical findings: Thickened ALL, narrowing vertebral disc, wedged vertebral bodies
•Histological findings: ratio of collagen to proteoglycan in the matrix of endplate is below normal → abnormal end plate ossification

Association:

•Spine: spondylolysis, scoliosis
•Pulmonary compromise
•Ddx of thoracic hyperkyphosis
•Postural kyphosis
•Compensation for Lumbar spondylolisthesis
•Congenital (NF dystrophic curve)
•Infection / tumour
•Symptoms
•Thoracic / lumbar pain (compensatory hyperlordosis)
•Pulmonary compromise in severe kyphosis
•Cosmesis
•Ataxic gait
•Knee FFC

Clinical findings:

•T kyphosis + compensatory L hyperlordosis
•Tight hamstring
•neurological deficits rare
Radiograph / imaging
Fig 1. Radiograph / imagingtop left
•Imaging findings
•Consecutive anterior wedging
•Endplate irregularity (Schmorl nodule), disc narrowing
•T Kyphosis + L compensatory lordosis
•Spondylolysis
•Scoliosis
•Ask for hyperextension lateral xray to see whether kyphosis is rigid or not
•Need supine hyperextension fulcrum view (rule out postural, also preop planning, <50% correction need anterior release)
•MRI for disc pathology, cord compression, epidural cyst, spinal stenosis

Treatment:

Conservative:

•Physio for stretching (<60 kyphosis)
•Hyperextension brace (controversial in growing patient)
•Operation
•PSF +/- Smith Peterson osteotomy (>75 Kyphosis/ neurological deficit/ severe pain)
•Adv of posterior: less blood loss and reduced surgical time
•Disadv: higher rate of pseudoarthrosis
•Anterior release needed if deformity does not correct to <50 on hyperextension lateral views
•Aim not to correct more than 50% of original deformity to prevent junctional kyphosis or cord compression

Direct Q&A

Q1 What diagnostic or radiographic findings support Scheurmann kyphosis?

Scheuermann's Kyphosis

Definition:

Sorensen criteria

•Rigid thoracic hyperkyphosis >45 deg (normal between 20 – 45 deg)
•Cause by anterior wedging of >5deg in 3 consecutive vertebrae
•Irregular endplate

Epidemiology:

•M > F
•AD inheritance, high penetrance with variable penetrance
•T > TL > L
Q2 What thresholds, cut-offs, or criteria are listed under Sorensen criteria?
•Rigid thoracic hyperkyphosis >45 deg (normal between 20 – 45 deg)
•Cause by anterior wedging of >5deg in 3 consecutive vertebrae
•Irregular endplate
Q3 What pathophysiology is described for Scheurmann kyphosis?
•Ring apophysis necrosis (occur at 12 yo)
•Cartilaginous endplate mechanical weakening
Q4 How is Scheurmann kyphosis managed?

Sorensen criteria

•Rigid thoracic hyperkyphosis >45 deg (normal between 20 – 45 deg)
•Cause by anterior wedging of >5deg in 3 consecutive vertebrae
•Irregular endplate

Epidemiology:

•M > F
•AD inheritance, high penetrance with variable penetrance
•T > TL > L

Pathophysiology:

•Ring apophysis necrosis (occur at 12 yo)
•Cartilaginous endplate mechanical weakening

Pathology:

•Anatomical findings: Thickened ALL, narrowing vertebral disc, wedged vertebral bodies
•Histological findings: ratio of collagen to proteoglycan in the matrix of endplate is below normal → abnormal end plate ossification

Association:

•Spine: spondylolysis, scoliosis

Raw speaker-note hierarchy audit

#lvlmarLindentlogicaloriginal note line
10NoneNone0Scheuermann's Kyphosis
20NoneNone0Definition:
30NoneNone0Sorensen criteria
40171450-1714501Rigid thoracic hyperkyphosis >45 deg (normal between 20 – 45 deg)
50171450-1714501Cause by anterior wedging of >5deg in 3 consecutive vertebrae
60171450-1714501Irregular endplate
70NoneNone0Epidemiology:
80171450-1714501M > F
90171450-1714501AD inheritance, high penetrance with variable penetrance
100171450-1714501T > TL > L
110NoneNone0Pathophysiology:
120171450-1714501Ring apophysis necrosis (occur at 12 yo)
130171450-1714501Cartilaginous endplate mechanical weakening
140000Pathology:
150171450-1714501Anatomical findings: Thickened ALL, narrowing vertebral disc, wedged vertebral bodies
160171450-1714501Histological findings: ratio of collagen to proteoglycan in the matrix of endplate is below normal --> abnormal end plate ossification
170NoneNone0Association:
180171450-1714501Spine: spondylolysis, scoliosis
190171450-1714501Pulmonary compromise
200000Ddx of thoracic hyperkyphosis
210171450-1714501Postural kyphosis
220171450-1714501Compensation for Lumbar spondylolisthesis
230171450-1714501Congenital (NF dystrophic curve)
240171450-1714501Infection / tumour
250NoneNone0Symptoms
260171450-1714501Thoracic / lumbar pain (compensatory hyperlordosis)
270171450-1714501Pulmonary compromise in severe kyphosis
280171450-1714501Cosmesis
290171450-1714501Ataxic gait
300171450-1714501Knee FFC
310000Clinical findings:
320171450-1714501T kyphosis + compensatory L hyperlordosis
330171450-1714501Tight hamstring
340171450-1714501neurological deficits rare
350NoneNone0Imaging findings
360171450-1714501Consecutive anterior wedging
370171450-1714501Endplate irregularity (Schmorl nodule), disc narrowing
380171450-1714501T Kyphosis + L compensatory lordosis
390171450-1714501Spondylolysis
400171450-1714501Scoliosis
410171450-1714501Ask for hyperextension lateral xray to see whether kyphosis is rigid or not
420000Need supine hyperextension fulcrum view (rule out postural, also preop planning, <50% correction need anterior release)
430000MRI for disc pathology, cord compression, epidural cyst, spinal stenosis
440000Treatment:
450171450-1714501Conservative:
461628650-1714502Physio for stretching (<60 kyphosis)
471628650-1714502Hyperextension brace (controversial in growing patient)
480171450-1714501OT:
491628650-1714502PSF +/- Smith Peterson osteotomy (>75 Kyphosis/ neurological deficit/ severe pain)
5021085850-1714503Adv of posterior: less blood loss and reduced surgical time
5121085850-1714503Disadv: higher rate of pseudoarthrosis
5221085850-1714503Anterior release needed if deformity does not correct to <50 on hyperextension lateral views
5321085850-1714503Aim not to correct more than 50% of original deformity to prevent junctional kyphosis or cord compression

Improved semantic hierarchy used for the study notes

#semantic levelsection?rewritten line
10Scheuermann's Kyphosis
20yesDefinition:
30yesSorensen criteria
41Rigid thoracic hyperkyphosis >45 deg (normal between 20 – 45 deg)
51Cause by anterior wedging of >5deg in 3 consecutive vertebrae
61Irregular endplate
70yesEpidemiology:
81M > F
91AD inheritance, high penetrance with variable penetrance
101T > TL > L
110yesPathophysiology:
121Ring apophysis necrosis (occur at 12 yo)
131Cartilaginous endplate mechanical weakening
140yesPathology:
151Anatomical findings: Thickened ALL, narrowing vertebral disc, wedged vertebral bodies
161Histological findings: ratio of collagen to proteoglycan in the matrix of endplate is below normal → abnormal end plate ossification
170yesAssociation:
181Spine: spondylolysis, scoliosis
191Pulmonary compromise
201Ddx of thoracic hyperkyphosis
211Postural kyphosis
221Compensation for Lumbar spondylolisthesis
231Congenital (NF dystrophic curve)
241Infection / tumour
251Symptoms
261Thoracic / lumbar pain (compensatory hyperlordosis)
271Pulmonary compromise in severe kyphosis
281Cosmesis
291Ataxic gait
301Knee FFC
310yesClinical findings:
321T kyphosis + compensatory L hyperlordosis
331Tight hamstring
341neurological deficits rare
351Imaging findings
361Consecutive anterior wedging
371Endplate irregularity (Schmorl nodule), disc narrowing
381T Kyphosis + L compensatory lordosis
391Spondylolysis
401Scoliosis
411Ask for hyperextension lateral xray to see whether kyphosis is rigid or not
421Need supine hyperextension fulcrum view (rule out postural, also preop planning, <50% correction need anterior release)
431MRI for disc pathology, cord compression, epidural cyst, spinal stenosis
440yesTreatment:
450yesConservative:
462Physio for stretching (<60 kyphosis)
472Hyperextension brace (controversial in growing patient)
481Operation
492PSF +/- Smith Peterson osteotomy (>75 Kyphosis/ neurological deficit/ severe pain)
503Adv of posterior: less blood loss and reduced surgical time
513Disadv: higher rate of pseudoarthrosis
523Anterior release needed if deformity does not correct to <50 on hyperextension lateral views
533Aim not to correct more than 50% of original deformity to prevent junctional kyphosis or cord compression
← PreviousIndexNext →