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Scheuermann’s disease
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Scheuermann’s disease
This type of kyphosis is most commonly seen in boys and may become noticeable during adolescence. It is normally related to abnormal development of the vertebrae in the spine ,usually the upper back, which leads to wedge-shaped, instead of rectangular-shaped vertebral bodies.
Additionally, there can be abnormal development of the intervertebral discs lading to herniations into the adjacent vertebrae (uncommonly into the spinal canal).
When this occurs, the vertebral endplate becomes irregular. Although the wedging of vertebrae in Scheuermann’s is most commonly in the thoracic spine, it may occur in the junction between the thoracic and lumbar spines.
Symptoms of Scheuermann’s disease
Tiredness and muscle stiffness, especially after a day of sitting in class
Redness on the skin where the curvature is most pronounced and rubs against the back of a chair
Muscle spasms or muscle cramps
Pain made worse by activities involving twisting, bending, or arching backward, such as when participating in gymnastics, figure skating, dancing, or other sports requiring these types of movements
Difficulty exercising
Back pain or backache, which may come and go
Limited flexibility
Feeling off-balance
Causes of Scheurmann’s disease
The cause of scheuermann’s disease is idiopathic which means that the cause is unknown, and it occurs it an otherwise totally normal, healthy child. Similar to scoliosis, Scheuermann’s disease is a hereditary condition, but it is multi-factorial so there is no clear inheritance pattern
Osteochondritis of the upper and lower cartilaginous vertebral plates has been incriminated in the development of Scheuermann’s disease.
Trauma sometimes seems to be a causative factor.
Diagnosing Scheuermann’s disease
An X-ray is usually required to confirm the diagnosis of Scheuermann’s disease. Other changes associated with the condition may also be present such as Schmorl’s Nodes
The curvature in Scheuermann’s disease is measured in degrees. If an X-ray demonstrates wedging of 5 degrees or more at three adjacent vertebrae then diagnosis of Scheuermann’s disease is made.A curvature with no abnormalities of the vertebrae (and one that goes away when the patient lies down) is usually considered postural kyphosis. However, Scheuermann’s disease is usually the diagnosis if the patient has:
- A curvature of 45 degrees or more
- Three or more adjacent vertebrae wedged together by at least 5 degrees per segment
Diagnosis of Scheuermann’s disease is based on a physical exam—including observation of posture—and analysis of X-rays and any other needed imaging test
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Treatment of Scheuermann’s disease
The treatment of Scheuermann’s disease depends upon the degree of kyphosis, the age of the patient and the levels of the spine that are affected. Early diagnosis is key in optimally treating this type of kyphosis. In a skeletally immature patients treatment for significant deformity is directed at bracing.
A custom brace is made and worn by the patient 23 hours a day during remaining growth in order to assist remodeling and corrected growth of the spine.Once an adolescent has stopped growing, or in older adults, bracing is no longer an effective option in correcting abnormal curvature.
When bracing, therapy and other non-operative treatments fail, surgery may be an option to consider. Each case must be approached in a very individual manner and a complete and thorough evaluation by an experienced specialist is important prior to planning any treatment program.
If surgery is considered, the goals must include correction of deformity, and obtaining a balanced and stable spine. Numerous techniques have been developed to treat severe kyphosis and new approaches such as endoscopic surgery appear promising
