Thoracic vertebral column deformities in children

Deformities of the thoracic spine can develop in three spatial dimensions. Isolated torsional irregularities are extremely rare. Lateral bending, the so called scoliotic deformity, is usually combined with a rotation of the vertebrae. Differentiating between the normal spine and the irregularly formed thoracic spine in the sagittal plane is difficult because the physiological deviation from a straight line (thoracic kyphosis) is associated with significant individual variability. It is therefore important to classify all thoracic deformities into structural (so called shape failures) and non-structural deformities. The latter involve posture dysfunction and incorrect posture. They develop without an anatomic malformation of the spine (e.g. malformation of a single vertebra), and are therefore reversible changes. Due to the forces that act an the spine, almost all thoracic deformities in the sagittal plane are kyphotic. In childhood, the vast majority of thoracic deformities are due to Scheuerman's disease, so-called juvenile kyphosis. The scoliotic deformities in childhood and adolescence are classified by their etiology. Almost 80% of all scoliotic deformities in childhood involve idiopathic scoliosis in which the underlying cause remains unknown. The therapeutic treatment of kyphotic and scoliotic deformities in childhood and adolescence depends on the age of the patient, the etiology, the severity of spinal deformity, and often on the progression of deformity over a defined time period. Treatment includes non-surgical as well as surgical options.