de Mauroy et al. Scoliosis 2010, 5:9 http://www.scoliosisjournal.com/content/5/1/9 Open Access REVIEW © 2010 de Mauroy et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Com- mons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduc- tion in any medium, provided the original work is properly cited. Review 7 th SOSORT consensus paper: conservative treatment of idiopathic & Scheuermann's kyphosis JC de Mauroy* 1 , HR Weiss 17 , AG Aulisa 2 , L Aulisa 2 , JI Brox 3 , J Durmala 4 , C Fusco 5 , TB Grivas 6 , J Hermus 7 , T Kotwicki 8 , G Le Blay 9 , A Lebel 10 , L Marcotte 11 , S Negrini 5 , L Neuhaus 12 , T Neuhaus 12 , P Pizzetti 5 , L Revzina 13 , B Torres 14 , PJM Van Loon 15 , E Vasiliadis 6 , M Villagrasa 16 , M Werkman 18 , M Wernicka 19 , MS Wong 20 and F Zaina 5 Abstract : Thoracic hyperkyphosis is a frequent problem and can impact greatly on patient's quality of life during adolescence. This condition can be idiopathic or secondary to Scheuermann disease, a disease disturbing vertebral growth. To date, there is no sound scientific data available on the management of this condition. Some studies discuss the effects of bracing, however no guidelines, protocols or indication's of treatment for this condition were found. The aim of this paper was to develop and verify the consensus on managing thoracic hyperkyphosis patients treated with braces and/ or physiotherapy. Methods: The Delphi process was utilised in four steps gradually modified according to the results of a set of recommendations: we involved the SOSORT Board twice, then all SOSORT members twice, with a Pre-Meeting Questionnaire (PMQ), and during a Consensus Session at the SOSORT Lyon Meeting with a Meeting Questionnaire (MQ). Results: There was an unanimous agreement on the general efficacy of bracing and physiotherapy for this condition. Most experts suggested the use of 4-5 point bracing systems, however there was some controversy with regards to physiotherapeutic aims and modalities. Conclusion: The SOSORT panel of experts suggest the use of rigid braces and physiotherapy to correct thoracic hyperkyphosis during adolescence. The evaluation of specific braces and physiotherapy techniques has been recommended. Background Kyphosis can be paradoxically more difficult to treat than scoliosis. There are many types of kyphosis that require various strategies of treatment. Furthermore, there is only a little evidence on the conservative treatment of kyphosis, less than that on scoliosis. With lacking infor- mation on the natural history, the difficulties of clinical and radiological assessment, the unclear definition of normal kyphosis and the variety of clinical forms and eti- ology, vague indications of treatment are allowed for at best. Untreated, kyphosis in the growing child may lead to a progressive deformity of the spine and back pain. At birth, the entire spine shows a slight posterior curve from the occiput to the sacrum. When the baby begins to hold his head up, a cervical lordotic curve develops. However with the sitting position a total kyphosis can be encour- aged. With weight bearing and ambulation, the pelvis tilts forward and a lumbar lordosis develops. Staffel [1] classi- fied human posture into three distinct groups: "round"," flat" and "lordotic." In the early twentieth century, radiographs allowed Scheuermann [2] in Copenhagen to describe and illus- trate anterior wedging of vertebral body. In 1939, Schmorl [3] described the alterations of the growth plate of the vertebral body and nodules that bear his name. In 1964, in his monograph Sorenson [4] does not find a solution to correct kyphosis. Subsequently many authors have proposed normal ranges of posterior sagittal thoracic curves of: 20°-40° for Roaf [5] and 30 ° for Rocher [6]. * Correspondence: demauroy@aol.com 1 Clinique du Parc, 155 bd Stalingrad, 69006 Lyon, France Full list of author information is available at the end of the article