β£What is Scheuermann Kyphosis?Defined as Rigid Thoracic kyphosis > 45 deg(cobb angle method), Anterior wedging of > 5 deg across 3 consecutive VBidiopathic conditionβ£Types of scheuermann kyphosis?Type 1 = thoracic spine onlyType 2 = both Thoracic and Lumbar spineβ£What is the prognosis of Scheuermann?< 75 deg β mild LBP rarely affecting ADL75 β 100 - severe LBP> 100 β pulmonary function compromiseβ£Classical features on XR?endplate irregularitiesSchmorlβs nodes (herniation of disc into VB)β£Management principles for severe kyphosis?Correct sagittal balance to < 5cm Sagittal Vertical Axisβ£What are the 3 osteotomy options for Kyphosis? Any other considerations?10/30/40 Β° correctionβ£Smith Petersen Osteotomy (SPO) = hinge at discaka Ponte Osteotomy aka Posterior column osteotomyExcision of posterior column with hinge at disc w disruption of disc10 deg/ segmentβ£Three Column Pedicle Subtraction Osteotomy (PSO) = hinge at anterior VBExcision of posterior cloumn and wedge of VB hinge at VB; No disruption of disc.30-40 deg/ segmentβ£Vertebral Column Resection (VCR)Remove of one VB with SPO done on adjacent levels45 deg/ segmentβ£ConsiderationsKinking of spinal cord - May need to lengthen anterior column with ageNerve roots - consider sacrificing if required