Scheuermann's Kyphosis: Difference between revisions
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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: | 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.<ref name="Meeusen" /> 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 | *The skeleton of a newborn consists mainly of cartilage, which in childhood is transformed into bone.<ref name="Meeusen" /> 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 kyphosis. | ||
*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. | *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. | *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. | ||
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*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="Blumenthal">Blumenthal S, Roach J, Herring J. Lumbar Scheuermann’s: a clinical series and classification. Spine 1987; 12:929-932.(2B)</ref><ref name="Eorthopod">Eorthopod. Content. Scheurmanns disease. www.eorthopod.com/content/scheuermanns-disease (accessed 20/10/2010).</ref> | *Mostly, the patients have a greater lordosis in the lumbar spine than normal people<ref name="Blumenthal">Blumenthal S, Roach J, Herring J. Lumbar Scheuermann’s: a clinical series and classification. Spine 1987; 12:929-932.(2B)</ref><ref name="Eorthopod">Eorthopod. Content. Scheurmanns disease. www.eorthopod.com/content/scheuermanns-disease (accessed 20/10/2010).</ref> | ||
*There also could be a correlation between disc generation, reduced intradisc distance and abnormal configurations of the vertebral bodies.<ref name="Meeusen" /><ref name="Blumenthal" /> | *There also could be a correlation between disc generation, reduced intradisc distance and abnormal configurations of the vertebral bodies.<ref name="Meeusen" /><ref name="Blumenthal" /> | ||
*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 20:06, 4 April 2013
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 kyphosis.
- 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]
- There also could be a correlation between disc generation, reduced intradisc distance and abnormal configurations of the vertebral bodies.[3][5]
- 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]
Patients who have Sheuermann's disease have progressive structural kyphosis throughout the adolescent period. [2]
At first, there will be single an altered posture and as good as no symptoms. As the disease progresses there will more complaints, which can be symptoms of the disease:
- Back pain and fatigue
- Muscle stiffness, 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, the disease will also stop. Only some residual abnormalitieswill 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]
Scheuermann's disease is diagnosed with lateral radiographs. With these pictures they define the degrees of anterior wedging of the vertebrae. The criterion of diagnosis is more than 5 degrees of wedging of at least 5 adjacent vertberae at the apex of the kyphosis. Schmorl nodes, irregularity and flattening of the vertebral end-plates and narrowing of the intervertebral disc spaces are also often seen on the radiographs.[2]
Diagnostic Procedures[edit | edit source]
Outcome Measures[edit | edit source]
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Examination[edit | edit source]
Patients with Scheuermann's disease normally have an angular thoracic or thoracolumbar kyphosis compensated by an hyperlordosis of the lumbar spine. Te kyphosis is fixed and stays apparant on hyperextension of the spine. The kyphosis is easier to see when seen from the side, when the patient bents forward.[2]
Often de cervical lordosis is increased with a protrusion of the head. These abnormalities can be accompanied by a mild to moderate scoliosis.[2]
Patients with Scheuermann's disease are well muscled compared to patients with postural kyphosis. [2]
Medical Management
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Physical Therapy Management
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Treatment of the Scheuermann's disease depends on the severity of the disease or the progression of the disease, the presence or absence of pain and the age of the patient.
Patients with a mild form are suggested to move and get a prescription from the doctor for physiotherapy. This includes exercises to maintain flexibility from the back, correct lumbar lordosis, and strengthen the extensors from the back.[2][3]. These exercise can be effective when the thoracic spine has not developed a relevant stiffness and when the sagittal curve is not too high (Cobb angles from 44° to 55°)[8]
Patients with back pain should follow a postural and aerobic training program. These postural exercises are not only use full to fight the pain but also to manage the deformity in the spine.[2]
Stretching exercises are also use full if there is tightness of the hamstring muscles.[2]
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.
Depending on the severity and progression of the curve, patients should follow, in conjunction of the exercises, a brace therapy (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.[9]
The patient must learn to move so the back is not under much stress.[10] 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 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 TG Lowe. Scheuermann disease. J Bone Joint Surg Am. 1990;72:940-945.(A1)
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 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.(2B)
- ↑ 6.0 6.1 6.2 Eorthopod. Content. Scheurmanns disease. www.eorthopod.com/content/scheuermanns-disease (accessed 20/10/2010).
- ↑ Gustavel M, Beals RK. Scheuermann’s disease of the lumbar spine in identical twins. American journal of roentgenology 2002; 179:1077-1080.
- ↑ F. Zaina et al. Review of rehabilitation and orthopedic conservative approach to sagittal plane diseases during growth: hyperkyphosis, junctional kyphosis, and Scheuermann disease. EUR J PHYS REHABIL MED 2009;45:595-603. (A1)
- ↑ 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).
