Supine fulcrum bending test and in-cast correction of Scheuermann juvenile kyphosis
Keywords:Scheuermann juvenile kyphosis, Scheuermann disease, Fulcrum bending test, Brace, Plaster cast brace
Background: Patients with Scheuermann disease often require conservative management with a series of corrective casts, followed by anti-kyphotic brace. Flexibility of the kyphosis can be assessed during a supine fulcrum bending test. The aim of the study was to analyze the radiological flexibility of kyphosis and immediate in-cast correction in a series of patients conservatively treated.
Methods: Eighty-six adolescents were conservatively treated for Scheuermann disease of thoracic location. Charts of 55 patients, 39 boys and 16 girls, were accessible. The mean age was 14.6±1.6 years. On the lateral full-cassette standing radiograph, the angle of thoracic and lumbar lordosis were measured. The flexibility of kyphosis was assessed on a supine fulcrum bending lateral radiograph. The in-cast kyphosis angle was measured on a standing lateral radiograph.
Results: In 18 patients, a mild non-progressive scoliotic curvature was present; it did not exceed a Cobb angle measurement of 25°. The initial kyphosis angle was 59.2°±9.3°. The lordosis angle was 76.3°±9.3°. The kyphosis angle on supine fulcrum bending test was 30.4°±9.7°. The kyphosis angle in the reclining cast was 44.3°±12.5°. There was no correlation between age and the supine bending correction. There was a correlation between the correction obtained with the supine bending test and the immediate correction in the cast (r=0.64, p=0.0012).
Conclusions: The reduction of the kyphosis Cobb angle by supine fulcrum bending was 50% on average, while in the cast in standing position, only half of this correction was maintained.
Lowe TG. Scheuermann's kyphosis. Neurosurg Clin N Am. 2007;18:305-15.
Lowe TG, Line BG. Evidence based medicine: analysis of Scheuermann kyphosis. Spine. 2007;32:115-9.
Damborg F, Engell V, Andersen M, Kyvik KO, Thomsen K. Prevalence, concordance, and heritability of Scheuermann kyphosis based on a study of twins. J Bone Joint Surg. 2006;88:2133-6.
Wood KB, Melikian R, Villamil F. Adult Scheuermann kyphosis: evaluation, management, and new developments. J Am Acad Orthop Surg. 2012;20:113-21.
Etemadifar MR, Jamalaldini MH, Layeghi R. Successful brace treatment of Scheuermann's kyphosis with different angles. J Craniovertebral Junction Spine. 2017;8:136-43.
Damborg F, Engell V, Nielsen J, Kyvik KO, Andersen MØ, Thomsen K. Genetic epidemiology of Scheuermann's disease. Acta Orthop. 2011;82:602-5.
Esapa CT, Hough TA, Testori S, Head RA, Crane EA, Chan CP, et al. A mouse model for spondyloepiphyseal dysplasia congenita with secondary osteoarthritis due to a Col2a1 mutation. J Bone Miner Res. 2012;27(2):413-28.
Ippolito E, Bellocci M, Montanaro A, Ascani E, Ponseti IV. Juvenile kyphosis: an ultrastructural study. J Pediatr Orthop. 1985;5:315-22.
Ippolito E, Ponseti IV. Juvenile kyphosis: histological and histochemical studies. J Bone Joint Surg Am. 1981;63(2):175-82.
Aulisa AG, Falciglia F, Giordano M, Mastantuoni G, Poscia A, Guzzanti V. Conservative treatment in Scheuermann's kyphosis: comparison between lateral curve and variation of the vertebral geometry. Scoliosis Spinal Disord. 2016;11(2):33.
Fotiadis E, Kenanidis E, Samoladas E, Christodoulou A, Akritopoulos P, Akritopoulou K. Scheuermann's disease: focus on weight and height role. Eur Spine J. 2008;17(5):673–8.
Palazzo C, Sailhan F, Revel M. Scheuermann's disease: an update. Joint, bone, spine: revue du rhumatisme. 2014;81:209-14.
Wenger DR, Frick SL. Scheuermann kyphosis. Spine. 1999;24:2630-9.
KH S. Scheuermann’s Juvenile Kyphosis: Clinical Appearances, Radiography, Aetiology and Prognosised. Copenhagen, Denmark, Munksgaard. 1964.
Sachs B, Bradford D, Winter R, Lonstein J, Moe J, Willson S. Scheuermann kyphosis. Follow-up of Milwaukee-brace treatment. J Bone Joint Surg. 1987;69:50-7.
Greene TL, Hensinger RN, Hunter LY. Back pain and vertebral changes simulating Scheuermann's disease. J Pediatric Orthop. 1985;5:1-7.
Bradford DS, Moe JH, Montalvo FJ, Winter RB. Scheuermann's kyphosis and roundback deformity. Results of Milwaukee brace treatment. J Bone Joint Surg. 1974;56:740-58.
Ristolainen L, Kettunen JA, Heliovaara M, Kujala UM, Heinonen A, Schlenzka D. Untreated Scheuermann's disease: a 37-year follow-up study. Eur Spine J. 2012;21:819-24.
Murray PM, Weinstein SL, Spratt KF. The natural history and long-term follow-up of Scheuermann kyphosis. J Bone Joint Surg. 1993;75:236-48.
Weiss HR, Turnbull D, Bohr S. Brace treatment for patients with Scheuermann's disease - a review of the literature and first experiences with a new brace design. Scoliosis. 2009;4:22.
de Mauroy JC, Weiss H, Aulisa A, Brox J, Durmala J, Fusco C, et al. 7th SOSORT consensus paper: conservative treatment of idiopathic & Scheuermann's kyphosis. Scoliosis. 2010;5:9.
Platero D, Luna JD, Pedraza V. Juvenile kyphosis: effects of different variables on conservative treatment outcome. Acta orthopaedica Belgica. 1997;63:194-201.
de Mauroy JC, Vallèse P, Fender P, Lecante C. Historical Lyonaise brace treatment for adolescent hyperkyphosis. Results of 272 cases reviewed 2 years minimum after removal of the brace. Scoliosis. 2010;5:69.
de Mauroy JC. Prospective study of 393 adolescent thoracic hyperkyphosis patients treated by the Lyon method. Scoliosis. 2013;8:50.
de Mauroy JC, Fender P, Tato B, Lusenti P, Ferracane G. Lyon brace. Studies in Health Technology and Informatics 2008;135:327-40.