Successful brace treatment of Scheuermann's kyphosis with different angles

BACKGROUND Scheuermann's disease is regarded as the most common cause of structural hyperkyphosis within adolescents without any proper treatment. It may lead to progressive deformity and back pain which influences patient's quality of life during adolescence and adulthood. Treatment approach to Scheuermann's kyphosis has not been clearly defined due to its different definitions and obscure natural history. The goal of treatment is not only to prevent progression but also to obtain permanent correction. Bracing, especially Milwaukee brace and physiotherapy are two of the common nonoperative treatment modalities. Hence, the present study intended to evaluate the effectiveness of Milwaukee brace on progression control as well as correction of Scheuermann's kyphosis. MATERIALS AND METHODS In a retrospective, observational study, all the patients diagnosed with Scheuermann's kyphosis were reviewed in 2003-2013, who were treated by Milwaukee brace at a single center. There was a minimum of 2-year follow-up after completion of bracing, during which clinical and radiological parameters were identified and recorded. RESULTS The mean angle of kyphosis in these patients at the presentation was 63.24 ± 9.96 and at the end of this study was 36.5° ± 13.4° (P < 0.001). Moreover, mean improved angle in those patients with <75° of kyphosis was 25.26° ± 7.78° and in those with 75° or more than 75° of kyphosis was 26.77° ± 19.76° (P < 0.001). CONCLUSION Conservative treatment with Milwaukee brace and physiotherapy was effective in our hand for halting kyphosis progression in 97.5% of Scheuermann's kyphosis, which could be advised for cases up to 90° of kyphosis before skeletal maturity. As a result, a trial of brace treatment could be recommended in patients with severe kyphosis (up to 90°) which can open a new insight in conservative treatment of Scheuermann's kyphosis.