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Also called “Scheuermann’s kyphosis,” it is a skeletal disorder involving abnormal spine growth.
Scheuermann’s disease is a spinal (skeletal) disease that usually occurs in children during adolescence.
It is often seen as a pronounced curvature or “hunched over,” If left untreated, it can lead to significant health complications later in life.
Studies suggest that up to 2% of the population can be affected by this disease.
Causes of Scheuermann’s disease
The actual cause of the condition is unknown, although there are certain genetic and hormonal links.
What is known is that the condition is more common in boys than girls and is often not diagnosed until later in life.
Scheuermann’s disease is caused by abnormal growth of bone in the vertebrae, potentially by an interruption of blood flow.
The condition typically occurs between 13 and 16 when the body goes through bouts of rapid and sudden growth.
This condition in the spine causes a defect in the secondary ossification centers of the vertebral bodies that affect the growth and development of the spine.
The stunted growth causes the vertebrae to become a wedge shape rather than a block.
This may be restricted to a pair of vertebral bodies, but it is known to affect the entire thoracic spine and even parts of the lumbar spine.
Symptoms of Scheuermann’s disease
Further growth along the upper section of the spine causes the vertebrae to come together and form a “hunched” back, or kyphosis.
The normal spine already curves in the chest region and the lumbar region.
However, with Scheuermann’s disease, growth is irregular, increasing the curvature of the kyphosis, usually in the rib region.
The child will usually complain of sudden, severe pain in the upper back and stiffness during periods of a rapid growth spurt; this will be aggravated by sports activities.
Occasionally patients do not experience any pain; in these cases, the first noticeable sign will be very poor posture.
The kyphosis will increase, causing the child to change his posture, his shoulders will slump forward, and his lower back will arch excessively backward in compensation.
Occasionally, the cases will be mild and will not produce any symptoms; these cases are most likely not diagnosed until adulthood.
Scheuermann’s disease is associated with progressive deformity, stiffness, and back pain.
While the pain often decreases over time, the deformity does not improve.
Neurological, cardiovascular, and respiratory symptoms are rare but can occur.
Diagnosis of Scheuermann’s disease
Scheuermann’s disease is not a disease but rather a growth abnormality that causes the thoracic spine to bend forward.
The thoracic spine typically has between 20 and 40 degrees of kyphosis to help balance the spine and the skeleton.
During development, if the anterior part of the vertebral body does not grow as fast as the posterior part, the vertebral body end with a slight wedge shape that causes the spine to lean towards kyphosis.
This can produce the humpback or gibbon directly over the mid-thoracic spine.
Scheuermann’s is considered a thoracic kyphosis of more than 40 degrees with structural changes in the vertebral bodies.
To diagnose Scheuermann’s disease, specialists begin by reviewing the medical history, performing a physical exam, and analyzing the test results.
A diagnosis is given if:
- Three vertebrae in a row show wedging of 5 degrees or more.
- The angle of the curvature of the spine (kyphosis) is 50 degrees or more.
Tests used to diagnose Scheuermann’s disease may include:
- X-rays: X- rays taken from the side help show if any vertebrae are embedded.
- MRI: MRIs show detailed images of the affected vertebrae, surrounding tissues, and spinal cord.
- CT scan: If needed, a CT scan can provide a more detailed view of the vertebrae.
Scheuermann’s disease treatment
Treatment is personalized for each child, whether the child receives physical therapy to focus on core strengthening, receives spinal braces, or undergoes surgery.
Treatment goals often focus on reducing the pain of the child or young adult due to this condition.
Bracing has had mixed success with Scheuermann’s kyphosis, as in most cases, reinforcement does not improve the deformity.
To better limit the condition’s progress, the bracing plan should begin early in the disease process.
It also takes dedication to stick with the bracing plan until the child is finished growing.
Since most patients do not seek medical help until the deformity is present, shoring is generally not a practical option for treatment.
While the child is going through these painful growth episodes, they should refrain from aggravating sports activities.
The use of heavily loaded weights, and cumbersome school backpacks, should be avoided, as should activities that promote poor posture or stress the upper back.
Bracing may be recommended for higher grade curves in a skeletally immature spine that is still growing.
In some circumstances, the child will be prescribed a back brace. These measures are to minimize damage to the vertebrae and prevent further injury.
Once the painful growth period is over, it is essential to strengthening your posture.
Many people find manipulative therapies such as physical therapy, chiropractic, and osteopathy to help mobilize stiff upper back joints and massage therapies such as the Bowen technique massage to loosen tight postural muscles.
Although it will not change the deformity, physical therapy can help strengthen the muscles of the trunk and relieve some of the pain.
The therapist will be able to prescribe rehabilitation exercises that will help strengthen the core postural muscles.
Yoga and Pilates can also be beneficial in strengthening your back for long-term support.
The deformity is often painless, with mild pain associated with heavy activity.
If the deformity progresses as growth occurs, back pain will sometimes become more common.
Observation is generally the treatment for curves up to 60 degrees.
In a few cases, conservative management is not successful; in these cases, surgical intervention may be necessary.
Depending on the flexibility of the curve, as demonstrated by the exceptional supine and reinforcement images, a one- or two-stage surgical approach can be undertaken.
This can usually be done through a thoracoscopic or endoscopic approach with minimally invasive surgery.
This will often prevent a full thoracotomy, which opens the chest to free the spine and discs for better correction.
After releasing the spine, or if the deformity is flexible on X-rays, posterior instrumentation and fusion are performed with a double screw and rod constructions similar to scoliosis surgery.
Implants (screws) are inserted and connected with a rigid rod to obtain and maintain alignment.
Bone grafts are also used to make a solid fusion where the rod is placed.
This allows the surgeon to essentially step back and shorten the posterior aspect of the spine, correcting the deformity.
The spine is fused with the pelvic bone graft, and patients generally do well if the deformity is corrected correctly and fusion occurs.
Surgical correction works to address the deformity that comes from having Scheuermann and prevents the curve from progressing.
Scheuermann’s disease prognosis
For the worst cases of Scheuermann’s disease, the effects can include:
- A rapid acceleration of degenerative disc disease.
- A sedentary lifestyle is a result of radiant spinal pain.
- Multiple surgeries to correct deformities of the spine and body.
- Debilitating pain in the lower back.
- Erosive osteoarthritis of the spine.
- Significant mental illness with severe depression and anxiety.
- Stress is associated with chronic pain.
