🦴 Section 720.4 · Kyphosis

Nelson Textbook of Pediatrics 22nd Edition | Kyphosis: excessive posterior curvature of thoracic spine. Scheuermann disease — most common structural hyperkyphosis, defined by >5° anterior wedging of ≥3 consecutive vertebral bodies. Apex lower thoracic (T7-T9). Postural kyphosis — flexible, corrects with extension, no wedging. Congenital kyphosis — failure of formation (Type I, high risk of neurologic deficit) or failure of segmentation (Type II). Treatment: observation for mild; bracing (Milwaukee for apex >T7, TLSO for lower) if >55-60° and growth remaining; surgery if >70-80°, progressive, painful, or cosmetic concerns.

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📋 30 Clinical Scenarios — Kyphosis

📇 High‑Yield Review Cards

🩺 Clinical Recognition: Kyphosis

Select a presentation to review diagnostic clues and management per Nelson 720.4.

📋 Stepwise Management of Kyphosis

🔑 Key Principles — Nelson Section 720.4
• Normal thoracic kyphosis: 20-50° (Cobb method T3-T12).
• Scheuermann disease: ≥5° wedging of ≥3 vertebrae, irregular endplates, Schmorl nodes. Rigid kyphosis (does not correct with extension).
• Postural kyphosis: Flexible, corrects with extension, no vertebral wedging. No treatment needed beyond reassurance/PT.
• Congenital kyphosis: Type I (anterior failure of formation) — high risk of neurologic deficit; Type II (anterior failure of segmentation). Surgical treatment indicated early.
• Treatment: Mild (<55°) → observe. 55-80° with growth remaining → brace (Milwaukee or TLSO). >70-80° or progressive/painful → surgery (posterior spinal fusion with osteotomies).

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Kyphosis (Nelson 720.4)