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Scheuermann Disease: Causes, Symptoms & Treatment
Scheuermann disease is a growth disorder of the spine occurring in adolescence, causing an increased thoracic kyphosis and a rounded back posture.
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Scheuermann disease is a growth disorder of the spine occurring in adolescence, causing an increased thoracic kyphosis and a rounded back posture.
What is Scheuermann Disease?
Scheuermann disease, also known as Scheuermann kyphosis or juvenile kyphosis, is a structural growth disorder of the spine that typically develops during adolescence. It causes individual vertebral bodies to become wedge-shaped, leading to an exaggerated curvature of the thoracic spine (kyphosis) and a characteristic rounded back. The condition was first described in 1921 by Danish orthopaedic surgeon Holger Werfel Scheuermann.
Causes
The exact cause of Scheuermann disease is not yet fully understood. Several contributing factors are discussed:
- Genetic predisposition: The condition frequently occurs in families, suggesting a hereditary component.
- Growth disorder of the vertebral bodies: During the growth spurt, the anterior portions of the vertebral bodies grow more slowly than the posterior portions, resulting in a wedge-shaped deformity.
- Mechanical loading: Increased stress on the spine during rapid growth phases is considered a contributing factor.
- Nutritional deficiencies: Low levels of vitamin D and calcium may negatively affect bone development.
Symptoms
Symptoms of Scheuermann disease can vary depending on severity:
- Rounded back (kyphosis): A visibly increased curvature of the upper spine.
- Back pain: Particularly in the affected region, often worsened by prolonged sitting or physical activity.
- Muscle fatigue: The altered posture places greater demands on the back muscles.
- Reduced mobility: Forward bending of the spine may be restricted.
- In severe cases: Neurological symptoms due to spinal cord compression are rare but possible.
Diagnosis
Scheuermann disease is typically diagnosed through:
- Physical examination: The physician assesses posture and the degree of spinal curvature.
- X-rays: The classic finding is wedge-shaped deformity of at least three consecutive vertebral bodies, each with a wedge angle of more than 5 degrees (measured by the Cobb angle method). Schmorl nodes – herniation of disc material into the vertebral body – may also be visible.
- MRI or CT scan: Used when neurological involvement is suspected or for detailed assessment of soft tissue structures.
Treatment
Conservative Treatment
Most cases of Scheuermann disease can be managed conservatively:
- Physiotherapy: Strengthening of back and abdominal muscles, combined with stretching of tightened chest muscles, to improve posture.
- Bracing: For curvature angles above 40–50 degrees in skeletally immature patients, a brace (e.g., Cheneau brace) may slow progression.
- Pain management: NSAIDs (non-steroidal anti-inflammatory drugs) may be used for significant pain relief.
- Physical activity: Sports such as swimming are recommended to strengthen muscles and reduce spinal load.
Surgical Treatment
Surgery is rarely necessary and is only considered in severe cases:
- Curvature angle exceeding 70–80 degrees despite conservative treatment
- Severe, treatment-resistant pain
- Neurological deficits
- Significant cosmetic impairment
The most common surgical procedure is posterior instrumentation and spinal fusion, which stabilises the spine in a corrected position.
Prognosis
The prognosis for Scheuermann disease is generally good. With early treatment, progression of the curvature can be halted and quality of life significantly improved. In adulthood, the structural vertebral changes are permanent, but regular physiotherapy exercises can help reduce pain in the long term.
References
- Lowe TG. Scheuermann disease. The Journal of Bone and Joint Surgery, 1990; 72(6): 940–945.
- Murray PM, Weinstein SL, Spratt KF. The natural history and long-term follow-up of Scheuermann kyphosis. The Journal of Bone and Joint Surgery, 1993; 75(2): 236–248.
- Bradford DS et al. Scheuermann kyphosis and roundback deformity. The Journal of Bone and Joint Surgery, 1974; 56(4): 740–758.
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