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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 79

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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 79. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Juvenile Kyphosis Scheuermann s Disease Chapter 28 775 In Type II Scheuermann s kyphosis the typical clinical features are diminished lumbar lordosis flat back Fig. 5f or a very mild lumbar kyphosis stiffness of the lumbar spine and local pain. Diagnostic Work-up Imaging Studies The definitive diagnosis of juvenile kyphosis can often be made by conventional radiographs alone. However MRI best shows endplate abnormalities premature disc degeneration and vertebral wedging. Computed tomography very seldom provides additional information and is rarely indicated. Standard Radiographs Plain lateral and posteroanterior radiographs of the whole spine with the patient in the standing position are the primary radiological investigations. In the lateral projection a more or less sharp hyperkyphosis of the thoracic spine with compensatory lumbar hyperlordosis is seen Fig. 4b . If necessary close-up radiographs are taken or MRI is performed to elucidate the bony structures in the area of interest. The vertebrae around the apex of the thoracic kyphosis show typical radiographic changes Fig. 6 Juvenile kyphosis is diagnosed on standard radiographs irregularity of the endplates wedging of vertebral bodies increased length of vertebral bodies loss of disc space height Schmorl s nodes not pathognomonic Figure 6. Typical radiographic features Type I Wedge shape and increased sagittal diameter of vertebral bodies irregularity of endplates and disc space narrowing a schematic drawing b radiographic example. Radiographic changes with age c 14-year-old boy and d 17-year-old boy. 776 Section Spinal Deformities and Malformations Thoracic kyphosis and lumbar lordosis are measured according to Cobb. The posteroanterior radiograph is checked for secondary scoliosis. Sagittal and frontal spinal balance is assessed. Extension films of the kyphotic area obtained with the patient in the supine position with a sandbag under the apex of the deformity are used to assess flexibility of the deformity.