Scheuermann Disease – Causes, Symptoms & Treatment
Scheuermann disease is a growth disorder of the spine occurring in adolescence, causing an abnormal forward curvature of the upper back known as kyphosis.
Things worth knowing about "Scheuermann disease"
Scheuermann disease is a growth disorder of the spine occurring in adolescence, causing an abnormal forward curvature of the upper back known as kyphosis.
What is Scheuermann Disease?
Scheuermann disease (also known as Scheuermann kyphosis or adolescent kyphosis) is a structural disorder of the spine that typically develops during the growth spurt of puberty. It is characterized by uneven ossification of the vertebral bodies, which become wedge-shaped and cause an exaggerated forward curve of the thoracic spine – commonly referred to as a rounded back or hyperkyphosis. The condition was first described in 1920 by Danish orthopedic surgeon Holger Scheuermann.
Causes
The exact causes of Scheuermann disease are not yet fully understood. Contributing factors may include:
- Genetic predisposition: The condition often runs in families, suggesting a hereditary component.
- Mechanical overload: Repeated stress on the vertebral growth plates during development may contribute to the disorder.
- Impaired bone maturation: Abnormal development of the endplates of the vertebral bodies is considered a central mechanism.
- Hormonal influences: Growth hormones and pubertal changes may also play a role.
Symptoms
Symptoms vary depending on the severity of the condition. Common signs include:
- Visible rounded back (hyperkyphosis) in the thoracic region
- Back pain, especially after prolonged sitting or physical activity
- Reduced flexibility of the spine
- Muscle tension in the back area
- In severe cases: neurological symptoms due to spinal canal narrowing (rare)
Many individuals first notice changes for cosmetic reasons. Pain often increases in adulthood if left untreated.
Diagnosis
Diagnosis is typically made through a combination of clinical examination and imaging studies:
- Physical examination: Assessment of spinal alignment and range of motion by a physician.
- X-ray imaging: Characteristic findings include wedge-shaped vertebrae and Schmorl nodes (herniations of intervertebral disc tissue into the vertebral body). A kyphosis angle exceeding 45 degrees is considered diagnostically significant.
- MRI (Magnetic Resonance Imaging): Used when neurological symptoms are present or for detailed assessment of intervertebral discs and the spinal cord.
Treatment
Treatment is tailored to the patient's age, severity of curvature, and presenting symptoms.
Conservative Treatment
- Physical therapy and exercise: Targeted exercises to strengthen the back muscles and improve posture form the cornerstone of treatment.
- Bracing: In adolescents with remaining growth potential, a spinal brace (e.g., Milwaukee or Cheneau brace) may correct or stabilize the curvature.
- Pain management: Anti-inflammatory medications (e.g., ibuprofen) help manage acute pain episodes.
- Sports activity: Swimming and back-strengthening sports are recommended to support musculature.
Surgical Treatment
Surgery is only necessary in rare cases, such as severe kyphosis (exceeding 70–75 degrees), persistent pain unresponsive to conservative measures, or neurological complications. In these situations, a spinal fusion (spondylodesis) is performed to correct and stabilize the spine.
Prognosis and Course
The prognosis for Scheuermann disease is generally favorable. Once skeletal growth is complete, the curvature typically does not progress further. Many patients live without significant complaints when treated early. However, back pain and degenerative spinal changes may occur in adulthood if the condition was severe or untreated.
References
- Lowe, T. G. (1990): Scheuermann disease. In: Journal of Bone and Joint Surgery, 72(6), 940–945.
- Wenger, D. R. & Frick, S. L. (1999): Scheuermann kyphosis. In: Spine, 24(24), 2630–2639.
- Murray, P. M. et al. (1993): The natural history and long-term follow-up of Scheuermann kyphosis. In: Journal of Bone and Joint Surgery, 75(2), 236–248.
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