Early Treatment Important
Early treatment is especially important to the adolescent patient. Left untreated, the curve progression can lead to significant problems later during adulthood. Routine follow-up is essential to properly monitor curve progression.

Treating Postural Kyphosis
Certain exercises may be recommended (eg, physical therapy) to strengthen the patient's paravertebral muscles. Further, the patient must make a conscious effort to work toward correcting and maintaining proper posture.

Treating Structural Kyphosis
Analgesics and anti-inflammatory medication may be used to provide relief. Padded orthoses can be used to control pain, but these do not control curve progression. The patient's age, remaining growth potential, degree of kyphosis, curve progression, and the amount of vertebral wedging determine treatment of Scheuermann's Disease.

Bracing is the standard treatment to control curve progression in adolescents. For curve correction, a Cervical Thoraco Lumbar Sacral Orthotic (CTLSO) may be worn for 24 hours per day for a period of one year.*

After the initial bracing period, the patient is weaned out of the brace. Bracing does not provide permanent benefit to patients 16 years or older. Adolescents may find bracing difficult because the brace can be uncomfortable, hot, rigid, unattractive and may make the patient self-conscious.

Surgery is a consideration when kyphosis is severe (e., >70 degree curve) and symptoms (eg, pain) are unrelieved by conservative treatment.

*The physician determines the type of brace and how it is to be worn (eg, hours per day, length of time).

Surgery
Surgery is indicated when:

• The deformity is progressive beyond severe angle (eg, 70 degrees for Scheuermann's kyphosis) or sagittal balance is significantly abnormal
• Neurologic symptoms exist
• When persistent pain cannot be alleviated using conservative treatment. In addition, adolescents with significant deformity, who may not respond to conservative therapy (eg, bracing) and adults with curve progression and/or chronic back pain, may be accorded surgery.

Spinal instrumentation and fusion are surgical procedures that may be used to treat spinal deformity and to provide permanent stability to the spinal column. These procedures join and solidify the level where a spinal element has been damaged or removed (eg, intervertebral disc). Instrumentation uses medically designed hardware such as rods, plates and screws. These devices hold the spine straight during while the spine heals.

Fusion is the adhesive process joining bony spinal elements. In severe cases, spinal fusion is performed both anteriorly (from the front) through thoracotomy (entering chest cavity) and posteriorly (from behind) using instrumentation.

Recovery and Conservative Treatment
Closely follow the physician and/or physical therapist's instructions including regular follow-up visits to monitor curve progression.

Physical therapy may be incorporated into the treatment plan to build strength, flexibility, and increase range of motion. The therapist may provide the patient a customized home exercise program.

Recovery from Surgery
Postoperative pain and/or discomfort should be expected. Patient Controlled Analgesia (PCA) enables the patient to control their pain without hospital staff assistance, and may be replaced by oral medication.

The patient may be encouraged to get up and walk the following day. Activity enhances circulation and healing.

Physical therapy is added post-operatively enabling the patient to build strength, flexibility, and increase range of motion. The patient continues physical therapy on an outpatient basis for a period of time. Additionally, the therapist provides the patient with a customized home exercise program.

Prior to release from the hospital, the patient is given written instructions and prescriptions for necessary medication. The patient's care continues during follow-up visits with their spinal surgeon.