Scheuermann's Kyphosis: Difference between revisions
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*Osteoporosis could also be responsible for the development of Scheuermann's disease. | *Osteoporosis could also be responsible for the development of Scheuermann's disease. | ||
*Some studies showed that there’s a genetic component | *Some studies showed that there’s a genetic component | ||
*Mostly, the patients have a greater lordosis in the lumbar spine than normal people<ref name="bl" /><ref name="Eorthopod" /> | *Mostly, the patients have 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" /> | ||
*Ascani et al. found that patients who had Scheuermann disease were taller than average and that their skeletal age was ahead of their chronological age. They also found an increased levels of growth hormone in these patients.<br>The importance of these findings remain unclear.<br> | *Ascani et al. found that patients who had Scheuermann disease were taller than average and that their skeletal age was ahead of their chronological age. They also found an increased levels of growth hormone in these patients.<br>The importance of these findings remain unclear.<br> | ||
Revision as of 23:52, 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] The disease can occur at each level of the lumbar spine, that's why it is called lumbar Scheuermann's disease.
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.
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. [4]
Many theories have been proposed for the etiology of Scheuermann's disease, but the real cause is still unclear. Here are some of these theories:
- The skeleton of a newborn consists mainly of cartilage, which in childhood is transformed into bone.[3] Schmorl found that the lumbar Scheuermann’s disease could be related to defects of ossification process. The defect is often located at the anterior of the lumbar vertebrae, more precisely at the endplates. This results in an anterior wedging of the vertebrae and thus an increased lordosis.
- Ferguson suggested that the anterior wedging could is caused by the persistence of the anterior vascular groove. It creates a weak point in the vertebrae witch can lead to collapse of the vertebral body. But these findings have not been observed in other studies.
- There could be mechanical factors contributing in the disease. Partial reversal of the anterior wedging has been noted in patients who wore a brace during the active odf the disease, suggesting that mechanical factors play a role in the development of the deformity.
- Osteoporosis could also be responsible for the development of Scheuermann's disease.
- Some studies showed that there’s a genetic component
- Mostly, the patients have a greater lordosis in the lumbar spine than normal people[5][6]
- Ascani et al. found that patients who had Scheuermann disease were taller than average and that their skeletal age was ahead of their chronological age. They also found an increased levels of growth hormone in these patients.
The importance of these findings remain unclear.
Source: [2]
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.[7][6]
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][5]
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.[8]
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.[9] 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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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 Verhaar JAN, van Mourik JBA. Osteochondrose en gerelateerde aandoeningen. In: Orthopedie. Bohn stafleu van Loghum: Springer, second revised press, 2008. p235 – 237.
- ↑ 2.0 2.1 TG Lowe. Scheuermann disease. J Bone Joint Surg Am. 1990;72:940-945.
- ↑ 3.0 3.1 3.2 3.3 3.4 Meeusen R., Letsels. In: Praktijkgids Rug- en nekletsels deel 1. Diegem: Kluwer Editorial, 1999. p163 – 164.
- ↑ Sorensen et al: Scheuermann’s Juvenile Kyphosis. Clinical Appearances, Radiography, Aetiology, and Prognosis. Copenhagen, Munksgaard,1964
- ↑ 5.0 5.1 Blumenthal S, Roach J, Herring J. Lumbar Scheuermann’s: a clinical series and classification. Spine 1987; 12:929-932.
- ↑ 6.0 6.1 Cite error: Invalid
<ref>tag; no text was provided for refs namedEorthopod - ↑ Gustavel M, Beals RK. Scheuermann’s disease of the lumbar spine in identical twins. American journal of roentgenology 2002; 179:1077-1080.
- ↑ Spine health. Conditions. Scoliosis. Juvenile disorder. www.spine-health.com/conditions/scoliosis/juvenile-disc-disorder (accessed 18/11/2010).
- ↑ Understand spine surgery. Articles. Lumbar Scheurmann disease. www.understandspinesurgery.com/Articles/Read/-Lumbar-Scheuermann's-Disease (accessed 20/11/2010).
