Scheuermann's Kyphosis

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Original Editors - Liza De Dobbeleer

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Search Strategy

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Definition/Description

Scheuermann’s disease, also known as juvenile osteochondrosis, is named after Holger Werfel Scheuermann. The disease is characterized by a defect in shape of the spine with a curvature of the spine as result.^[1] People who suffer with this disease have irregularities of the vertebral endplates, the presence of Schmorl's nodes, disk-space narrowing and vertebral wedging.^[2] (5) At each level of the lumbar vertebrae can prevent this abnormality, hence the name lumbar Scheuermann’s disease. The disease mostly develops during puberty and is seen equally in both sexes. Depending on which criteria is used, has 5 to 40% of the population this anomaly.^{[1] [3]}
The skeleton of a newborn consists mainly of cartilage, which in childhood is almost completely transformed into bone.^[3] The lumbar Scheuermann’s disease is related to defects in the ossification process. This is often located at the anterior of the lumbar vertebrae (usually the first lumbar vertebrae to the fourth). This is the reason why these patients exhibit an increased lordosis.
The disease can range from mild to a server life-threatening deformity. Some people have no problems (mild threatening) but others will experience problems such as increasing curved spine, pain, neurological problems and symptoms of heart or lung problems. Although there’s no real condition discovered, deserve some typically elements of the disease special attention of researchers. Some studies showed that there’s a genetic component, Ascani et al also proved that patients with the condition are often taller than others of similar age. Mostly, the patients have a greater lordosis in the lumbar spine than normal people.[4] (2B) [5]
In addition, it has been suggested that between 20 to 30% of patients with Scheuermann’s disease also have scoliosis. In more serious cases, the combination is sometimes known as kyphoscoliosis.

Clinically Relevant Anatomy

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Epidemiology /Etiology

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Characteristics/Clinical Presentation

At first, there will be single an altered posture and as good as no symptoms, as the disease progresses there will be created fatigue of back muscles. Also muscle stiffness is a frequently symptom, especially at the end of the day (e.g. after a whole day sitting in the classroom). Because the body compensates the deviations in the spine there will be occur tensions in the lower back muscles. In severe cases, heart and lung function can be impaired. Very severe neurological symptoms may occur, but this is rare.
Lordosis caused by the disease can lead to a decreased flexibility of the torso.
After the puberty we stop growing so the disease will also stop. Single the residual abnormalities will exist.
There’s no conclusive evidence that people with the lumbar Scheuermann’s disease have more chance of low back pain compared with healthy people. So, more research is needed.^{[3] [5]}

Differential Diagnosis

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Diagnostic Procedures

The true underlying cause is still unknown. Researchers agree that there’s a genetic factor.
So believed Scheuermann that the cause was a necrosis of the vertebral body. Later research showed a correlation between disc generation, reduced intradisc distance and abnormal configurations of the vertebral bodies.^{[3] [4]} (2B)

Outcome Measures

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Examination

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Medical Management

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Physical Therapy Management

By a mild form is moving designated, the doctor will prescribed sessions with the physiotherapist. There, the patient will do exercise to train his back and abdominal muscles. The goal is keep the back supple. The back should be extend as much as possible eg. by mobilization or stabilization exercises.^[3]
Depending on the severity and progression of the curve, patients may be prescribed a brace (e.g. a Milwaukee brace) for one to two years. The brace can improve the curve during the growing years by restoring height to the front of the vertebral body and sometimes can reduce pain if present. Many studies have proved that for patients who are already skeletally mature, bracing is not an effective treatment.^[6]
Just as by the milder form will exercise designated to guarantee the muscle condition. The physiotherapist will also learn the patient how to keep the back in a correct attitude.
The patient must learn to move so the back is the least stress.^[7]
So is volleyball, sailing,… (static loads) not recommended, but swimming, ball games etc. (dynamic loads) are however recommended.
In severe cases, surgery can provide a solution.^[3]

Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

¹ Verhaar JAN, van Mourik JBA. Osteochondrose en gerelateerde aandoeningen. In: Orthopedie. Bohn stafleu van Loghum: Springer, second revised press, 2008. p235 – 237.
² Gustavel M, Beals RK. Scheuermann’s disease of the lumbar spine in identical twins. American journal of roentgenology 2002; 179:1077-1080.
³ Meeusen R., Letsels. In: Praktijkgids Rug- en nekletsels deel 1. Diegem: Kluwer Editorial, 1999. p163 – 164.
⁴ Blumenthal S, Roach J, Herring J. Lumbar Scheuermann’s: a clinical series and classification. Spine 1987; 12:929-932.
⁵ Eorthopod. Content. Scheurmanns disease. www.eorthopod.com/content/scheuermanns-disease (accessed 20/10/2010).
⁶ Spine health. Conditions. Scoliosis. Juvenile disorder. www.spine-health.com/conditions/scoliosis/juvenile-disc-disorder (accessed 18/11/2010).
⁷ Understand spine surgery. Articles. Lumbar Scheurmann disease. www.understandspinesurgery.com/Articles/Read/-Lumbar-Scheuermann's-Disease (accessed 20/11/2010).