Atypical Scheuermann's disease with severe kyphosis and negative sagittal balance in the thoracolumbar region: A case report and literature review

Seyed Reza Mousavi; Majid Reza Farrokhi; Alireza Liaghat; Amirhossein Hassani; Ali Kazeminezhad; Fariborz Ghaffarpasand

doi:10.1016/j.ijscr.2023.108618

Atypical Scheuermann's disease with severe kyphosis and negative sagittal balance in the thoracolumbar region: A case report and literature review

Int J Surg Case Rep. 2023 Aug:109:108618. doi: 10.1016/j.ijscr.2023.108618. Epub 2023 Aug 4.

Authors

Seyed Reza Mousavi¹, Majid Reza Farrokhi², Alireza Liaghat¹, Amirhossein Hassani¹, Ali Kazeminezhad³, Fariborz Ghaffarpasand⁴

Affiliations

¹ Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
² Shiraz Neurosciences Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: farokhim@sums.ac.ir.
³ Department of Neurosurgery, Peymanieh Hospital, Trauma Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.
⁴ Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: fariborz.ghaffarpasand@gmail.com.

Abstract

Introduction and importance: Scheuermann's kyphosis is a structural deformity of the thoracolumbar spine that is classified in typical (thoracic) and atypical (lumbar and thoracolumbar) Scheuermann's disease. Surgical intervention is reserved for those with progressive kyphosis, intractable pain and neurological impairment. Although, previous literature focuses on the correction of the thoracic kyphosis (TK), recent lines of evidence recommend considering all the sagittal balance parameters when performing a surgery. We herein, report a posterior-only approach in a patient with Scheuermann's kyphosis, considering all the sagittal balance parameters.

Case presentation: The patient was a 17-year-old boy with a kyphotic deformity in the lumbar region, with urinary retention and upper back intractable pain. The preoperative physical examination was normal except for a kyphotic gait. The patient was first treated with thoracic lumbosacral orthoses (TLSO) brace that was not effective; consequently, the patient underwent posterior only approach (pedicular screw fixation along with Smith-Peterson osteotomy) with correction of the sagittal balance and kyphosis. The patient's sign and symptoms improved significantly. The surgery was uneventful and no complication was recorded. The 1-year follow-up revealed normal neurological examination and normal sagittal balance parameters.

Clinical discussion: Atypical Scheuermann's kyphosis with neurological impairment and progressive kyphosis should be treated with surgical intervention.

Conclusion: Considering the sagittal parameters of the spine, the surgical intervention should be designed to correct the kyphosis and the other indices of the sagittal balance. Posterior-only approach is safe and effective method for correction of the TK and improving the signs and symptoms of the patients.

Keywords: Kyphosis; Negative sagittal balance; Scheuermann's disease; Smith-Peterson osteotomy; Thoracolumbar kyphosis.

Publication types

Case Reports