Background: Scheuermann’s kyphosis (SK) is characterized by anterior wedging of >5 degrees at three or more contiguous vertebrae associated with severe back pain and cosmetic disfigurement. Different surgical interventions have been applied for SK correction, but the optimal operational treatment remains controversial. Objectives: The aim of our study is to analyze all the current indications for the surgical correction of SK, as well as to describe the instrumentation methods and techniques in order to detect the ideal operational management and accompanied complications. Methods: This comprehensive review investigates the up-to-date surgical indications and approaches for SK, the current trends, and the associated postoperative functional outcomes. A detailed search of PubMed, Web of Science and Google Scholar databases in English literature was performed for articles during the last 20 years. Additional criteria were peer-reviewed original studies that provided the type of interventions for SK and the clinical outcomes. Results: Thirty studies that met our induction criteria were analyzed. The up-to-date surgical indications such as back pain, failure of conservative treatment, progression of deformity, and neurological complications were described. Anterior (AO) and posterior-only (PO), and combined anterior–posterior (AP) approaches and instrumentation techniques were outlined. The most common side effects of the above interventions were hardware failure, loss of correction and Proximal Junctional Kyphosis. Contrariwise, in PO, reduced blood loss and operational duration was noted. Conclusions: Although the published studies reported contradictory results of the effectiveness of the various techniques applied for SK treatment, the PO fusion was correlated with a decreased rate of complications that resulted in its current increase in popularity.

Scheuermann’s kyphosis (SK) is a rigid dorsal kyphosis of unclear pathophysiological origin. The aim of this review is to summarise current theories and both clinical and experimental findings regarding the underlying mechanisms of SK. Emerging evidence highlights the significant role of excessive mechanical loading as a major contributor to defective growth of the cartilaginous vertebral endplate. This is associated with the formation of Schmorl’s nodes, disruption of the ring apophysis, and compromised intervertebral disc integrity—ultimately resulting in vertebral body wedging and thickening of the anterior longitudinal ligament. In addition, numerous studies have investigated the genetic contribution and underlying molecular mechanisms involved in the pathogenesis of SK. Recent in vivo findings suggest an association between asymmetric mechanosensory activation of cerebrospinal fluid (CSF), contacting neurons, and defective Reissner fibre signalling, which may contribute to abnormal spinal morphogenesis in the sagittal thoracic plane. These findings indicate a potential link between altered CSF dynamics and the development of SK. Taken together, the evidence supports a multifactorial aetiology, with both genetic and biomechanical factors playing central roles in the development of Scheuermann’s kyphosis. The interpretation of the underlying pathophysiological mechanism could result in the early detection of the subjects that may have genetical predisposition for SK appearance and the development of target molecular treatments in order to counter the progression of the deformity.