Hyperkyphosis | Scheuermanns Disease

An Overview of Hyperkyphosis & Scheuermann’s Disease

A normal curvature of the spine exists with every human. The thoracic spine has a natural curve viewed on the side called a kyphosis. The vertebral bodies are wedged shaped and are the reason the curve is shaped like a kyphosis. The normal curve of the spine measures from 20-40 degrees. When this normal curve is disrupted, a deformity of the spine coupled with thoracic back pain can result.

This curve is essential for postural balance. There are two mirror image curves above and below (the cervical and lumbar curves). When added together with the sacral curve (the base bone of the spine is normally angulated 40 degrees to the front) the spine is in perfect balance. This means the head is positioned directly over the pelvis and no energy in the form of muscle contraction is necessary to stay upright.

This balance can be distorted by increasing the thoracic kyphosis as is seen in degenerative hyperkyphosis syndrome, Scheuermann’s Disease and postural round-back deformity. An unnatural curvature of the spine is detected in all of these disorders of the spine because the thoracic curve is increased and the balance of the spine is put off.

Compensation needs to come from the lumbar spine and cervical spine in the form of increased lordotic curves (the opposite curves to the thoracic curve to balance the spine). Without increased curves in these areas, the patient will either be thrown forward (if the lumbar curve does not increase) or have the head looking down instead of forward (if the cervical curve does not increase).

A helpful video on this website: “Hump-Back, Increased Thoracic Kyphosis, Scheuermanns Disease and Degenerative Kyphosis” helps to demonstrate the importance of normal balance and how the normal curves of the spine (cervical and lumbar lordosis and thoracic kyphosis) balance each other out. These disorders of the spine are examined in this video.

Symptoms Associated with Hyperkyphosis & Scheuermann’s Disease

The increased cervical and lumbar curves create amplified wear on the facets as the neck and lower back have to hyperextend (bend further backwards) to accommodate the thoracic imbalance. The increased curves have to be “held in place” by increased muscle contraction which causes muscle fatigue and pain from prolonged muscle contraction. Neck and or lower back pain will result.

The thoracic spine can generate local thoracic back pain from overload of the vertebral bodies and discs. In addition, with aging, arthritis of the spine, and osteoporosis, the increased loading of the vertebra can cause fractures of the spine by simply stepping off a curb too hastily.

Fatigue and muscle spasms can be a common complaint with hyperkyphosis / Scheuermann’s Disease as muscle overload uses too much energy. Prolonged walking or activities that require being upright can cause exhaustion.

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(Please keep reading below for more information on this condition.)

Treatment for Hyperkyphosis & Scheuermann’s Disease

Non-Surgical

Like with most other disorders of the spine, physical therapy using prescribed exercises for the spine, chiropractic treatment of the spine, medications and injections can be very helpful to manage the thoracic back pain associated with hyperkyphosis / Scheuermann’s Disease.

Surgical

Surgery for the treatment of kyphosis or for a deformity of the spine where the natural curve exceeds 65 degrees can be considered. Surgery is no small undertaking as the curve has to be straightened and there are significant risks to surgery. If the curve is under 65 degrees, a more conservative form of treatment of kyphosis should be discussed with your doctor.

For more information on curvature of the spine, or a specific deformity of the spine such as thoracic kyphosis, degenerative hyperkyphosis syndrome, Scheuermann’s Disease and postural round-back deformity, please contact the office of Dr. Donald Corenman, back surgeon and spine specialist offering diagnostic and surgical second opinions to patients in the USA and around the world.

(Click to Enlarge Image) This is a picture of the normal alignment of the spine when viewed from the side (sagittal alignment). The curves of the neck and lower back are in the same direction (lordosis) and the mid-back curve (kyphosis) is reversed. All curves add up to make the spine align with the head directly over the pelvis.

(Click to Enlarge Image) This is a side view diagram of a patient with Scheuermann’s hyperkyphosis disease. The mid back (thoracic spine) has a much bigger curve than normal. Note the thick black arrow pointing to the increased curve. This causes the patient to be tilted forward (see the thin gravity line in front of the pelvis which should be pointed into the pelvis). To compensate, the patient must increase the size of the lumbar curve which can prematurely wear it out.

(Click to Enlarge Image) This is an illustration of a patient with Scheuermann’s disease. Note the prominent curve or “hump’ in his mid-back.

(Click to Enlarge Image) This is an x-ray of the side view of the thoracic spine of a patient with Scheuermann’s disease. Note that the curve looks like a letter “C” but should be almost straight.

Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Hyperkyphosis / Scheuermann’s Disease