This 1998 narrative review by Tribus covers the diagnosis and management of Scheuermann's kyphosis in adolescents and adults — addressing radiographic criteria, natural history, indications for bracing, and surgical decision-making including approach selection and fusion-level principles.
When an adolescent presents with a rigid thoracic kyphosis and three or more wedged vertebrae ≥5 degrees, initiate Milwaukee bracing if the curve is progressive and skeletal maturity remains — but counsel families that curves ≥74 degrees have roughly a one-in-three chance of brace failure and eventual surgery.
In the adult with refractory thoracic or low back pain and a fixed kyphosis ≥60 degrees, conservative measures are first-line, but when surgery is planned, internalize the Lowe-Kasten rule: correct no more than half the deformity and anchor distally to the first lordotic disk or risk junctional failure.
This 1998 narrative review by Tribus covers the diagnosis and management of Scheuermann's kyphosis in adolescents and adults — addressing radiographic criteria, natural history, indications for bracing, and surgical decision-making including approach selection and fusion-level principles.
When an adolescent presents with a rigid thoracic kyphosis and three or more wedged vertebrae ≥5 degrees, initiate Milwaukee bracing if the curve is progressive and skeletal maturity remains — but counsel families that curves ≥74 degrees have roughly a one-in-three chance of brace failure and eventual surgery.
In the adult with refractory thoracic or low back pain and a fixed kyphosis ≥60 degrees, conservative measures are first-line, but when surgery is planned, internalize the Lowe-Kasten rule: correct no more than half the deformity and anchor distally to the first lordotic disk or risk junctional failure.