Scheuermann's Kyphosis: Difference between revisions
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== Definition/Description == | == Definition/Description == | ||
Scheuermann’s disease, also known as juvenile osteochondrosis, is named after Holger Werfel Scheuermann. <ref name="Verhaar Jan">Verhaar JAN, van Mourik JBA. Osteochondrose en gerelateerde aandoeningen. In: Orthopedie. Bohn stafleu van Loghum: Springer, second revised press, 2008. p235 – 237.</ref>The disease is characterized by a structural kyphosis of the thoracic or thoracolumbar spine.<ref name="TG Lowe">TG Lowe. Scheuermann disease. J Bone Joint Surg Am. 1990;72:940-945.</ref><sup> </sup>People who suffer with this disease have irregularities of the vertebral endplates, the presence of Schmorl's nodes, disk-space narrowing and vertebral wedging.<ref name="Gustavel M">Gustavel M, Beals RK. Scheuermann’s disease of the lumbar spine in identical twins. American journal of roentgenology 2002; 179:1077-1080.</ref><ref name="Eorthopod">Eorthopod. Content. Scheurmanns disease. www.eorthopod.com/content/scheuermanns-disease (accessed 20/10/2010).</ref> At each level of the lumbar vertebrae this abnormality can occur, hence the name lumbar Scheuermann’s disease.<br>The skeleton of a newborn consists mainly of cartilage, which in childhood is almost completely transformed into bone.<ref name="Meeusen">Meeusen R., Letsels. In: Praktijkgids Rug- en nekletsels deel 1. Diegem: Kluwer Editorial, 1999. p163 – 164.</ref>The lumbar Scheuermann’s disease is related to defects in the ossification process. This is often located at the anterior side of the lumbar vertebrae (usually the first lumbar vertebrae to the fourth). This is the reason why these patients exhibit an increased lordosis.<br>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, heart or lung problems. Although there’s no real condition discovered, there are some typically elements of the disease that deserve 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 [[Low Back Pain Related to Hyperlordosis|a greater lordosis in the lumbar spine]] than normal people.<ref name="bl">Blumenthal S, Roach J, Herring J. Lumbar Scheuermann’s: a clinical series and classification. Spine 1987; 12:929-932.</ref><ref | Scheuermann’s disease, also known as juvenile osteochondrosis, is named after Holger Werfel Scheuermann. <ref name="Verhaar Jan">Verhaar JAN, van Mourik JBA. Osteochondrose en gerelateerde aandoeningen. In: Orthopedie. Bohn stafleu van Loghum: Springer, second revised press, 2008. p235 – 237.</ref>The disease is characterized by a structural kyphosis of the thoracic or thoracolumbar spine.<ref name="TG Lowe">TG Lowe. Scheuermann disease. J Bone Joint Surg Am. 1990;72:940-945.</ref><sup> </sup>People who suffer with this disease have irregularities of the vertebral endplates, the presence of Schmorl's nodes, disk-space narrowing and vertebral wedging.<ref name="Gustavel M">Gustavel M, Beals RK. Scheuermann’s disease of the lumbar spine in identical twins. American journal of roentgenology 2002; 179:1077-1080.</ref><ref name="Eorthopod">Eorthopod. Content. Scheurmanns disease. www.eorthopod.com/content/scheuermanns-disease (accessed 20/10/2010).</ref> At each level of the lumbar vertebrae this abnormality can occur, hence the name lumbar Scheuermann’s disease.<br>The skeleton of a newborn consists mainly of cartilage, which in childhood is almost completely transformed into bone.<ref name="Meeusen">Meeusen R., Letsels. In: Praktijkgids Rug- en nekletsels deel 1. Diegem: Kluwer Editorial, 1999. p163 – 164.</ref>The lumbar Scheuermann’s disease is related to defects in the ossification process. This is often located at the anterior side of the lumbar vertebrae (usually the first lumbar vertebrae to the fourth). This is the reason why these patients exhibit an increased lordosis.<br>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, heart or lung problems. Although there’s no real condition discovered, there are some typically elements of the disease that deserve 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 [[Low Back Pain Related to Hyperlordosis|a greater lordosis in the lumbar spine]] than normal people.<ref name="bl">Blumenthal S, Roach J, Herring J. Lumbar Scheuermann’s: a clinical series and classification. Spine 1987; 12:929-932.</ref><ref name="Eorthopod" /><br>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.<br><br> | ||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
Revision as of 22:33, 16 May 2011
Original Editors - Liza De Dobbeleer
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Search Strategy[edit | edit source]
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Definition/Description[edit | edit source]
Scheuermann’s disease, also known as juvenile osteochondrosis, is named after Holger Werfel Scheuermann. [1]The disease is characterized by a structural kyphosis of the thoracic or thoracolumbar spine.[2] People who suffer with this disease have irregularities of the vertebral endplates, the presence of Schmorl's nodes, disk-space narrowing and vertebral wedging.[3][4] At each level of the lumbar vertebrae this abnormality can occur, hence the name lumbar Scheuermann’s disease.
The skeleton of a newborn consists mainly of cartilage, which in childhood is almost completely transformed into bone.[5]The lumbar Scheuermann’s disease is related to defects in the ossification process. This is often located at the anterior side 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, heart or lung problems. Although there’s no real condition discovered, there are some typically elements of the disease that deserve 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.[6][4]
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[edit | edit source]
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Epidemiology /Etiology[edit | edit source]
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] In the United States the disease occurs in 0,4 to 8 per cent of the general population. [7]
Characteristics/Clinical Presentation[edit | edit source]
At first, there will be single an altered posture and as good as no symptoms. As the disease progresses there will be fatigue of the back muscles. Muscle stiffness is also a frequently seen symptom, especially at the end of the day (e.g. after a whole day sitting in the classroom). These tensions in the lower back muscles are a result from the body that wants to compensate the deviations in the spine. 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 growth stops, so the disease will also stop. Only some 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[edit | edit source]
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Diagnostic Procedures[edit | edit source]
The true underlying cause is still unknown. Researchers agree that there’s a genetic factor.
Scheuermann believed 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[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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For patients with a mild form moving is designated. The doctor will prescribed sessions with the physiotherapist. There, the patient will do exercise to train his back and abdominal muscles. The goal of these exercises is to keep the back supple. The back should also be extend as much as possible eg. by mobilization and 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 or two years. The brace can influence the curve during growth 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]
Also in severe cases exercise will be designated to guarantee the muscle condition. The physiotherapist will also learn the patient how to keep the back in a correct position.
The patient must learn to move so the back is not under much 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[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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References[edit | edit source]
- ↑ Verhaar JAN, van Mourik JBA. Osteochondrose en gerelateerde aandoeningen. In: Orthopedie. Bohn stafleu van Loghum: Springer, second revised press, 2008. p235 – 237.
- ↑ TG Lowe. Scheuermann disease. J Bone Joint Surg Am. 1990;72:940-945.
- ↑ Gustavel M, Beals RK. Scheuermann’s disease of the lumbar spine in identical twins. American journal of roentgenology 2002; 179:1077-1080.
- ↑ 4.0 4.1 Eorthopod. Content. Scheurmanns disease. www.eorthopod.com/content/scheuermanns-disease (accessed 20/10/2010).
- ↑ Meeusen R., Letsels. In: Praktijkgids Rug- en nekletsels deel 1. Diegem: Kluwer Editorial, 1999. p163 – 164.
- ↑ Blumenthal S, Roach J, Herring J. Lumbar Scheuermann’s: a clinical series and classification. Spine 1987; 12:929-932.
- ↑ Sorensen et al: Scheuermann’s Juvenile Kyphosis. Clinical Appearances, Radiography, Aetiology, and Prognosis. Copenhagen, Munksgaard,1964
