Scheuermann's kyphosis.

Scheuermann's disease is the most common cause of structural kyphosis in adolescents. The kyphotic deformity is frequently attributed to "poor posture," resulting in delayed diagnosis and treatment. Indications for treatment remain somewhat debated, because the true natural history of the disease has not been clearly defined. Brace treatment is almost always successful in patients with kyphosis between 55 degrees and 80 degrees if the diagnosis is made before skeletal maturity. Kyphosis greater than 80 degrees in the thoracic spine or 65 degrees in the thoracolumbar spine is almost never treated successfully without surgery in symptomatic patients. Surgical treatment in adolescents and young adults should be considered if there is documented progression, refractory pain, loss of sagittal balance, or neurologic deficit. The major postoperative complication after surgical treatment is junctional kyphosis proximally or distally, which is usually related to not including all levels of the kyphosis or overcorrection of the deformity (>50%). With proper patient selection, excellent outcomes can be expected with nonoperative or operative treatment in patients with Scheuermann's disease.