Scheuermann disease is a disease in which there is a progressive kyphotic curvature of the spinal column. Occurs at puberty, is equally common in boys and girls. In the early stages, the symptoms are erased. Subsequently, there are pains and visible deformity of the spine – a stooped round back, in severe cases, a hump is possible. In some cases, neurological complications develop. To confirm the diagnosis, radiography, CT and MRI are performed. Treatment is usually conservative, with severe deformities surgical interventions are performed.
ICD 10
M42.0 Juvenile osteochondrosis of the spine
Meaning
Scheuermann disease (juvenile kyphosis) is a progressive increase in thoracic kyphosis. In 30% of patients it is combined with scoliosis. The first manifestations occur in adolescents, at the stage of the most active growth of the child. A fairly common pathology, detected in 1% of children older than 8-12 years, affects girls and boys equally often. In severe cases, curvature of the spine can cause the development of neurological complications, complicate the work of the lungs and heart.
Causes
The exact causes of Scheuermann disease are unknown. Most experts believe that there is a genetic predisposition to the development of this disease. Along with this, injuries during the period of intensive growth, osteoporosis of the vertebrae, excessive development of bone tissue in the posterior vertebrae, necrosis of the end plates of the vertebrae and impaired development of the back muscles are considered as starting points. The predisposing factor is uneven shifts in hormonal balance and metabolism during puberty.
Pathanatomy
The human spine has four natural bends: the lumbar and cervical sections are bent forward (lordoses), the sacral and thoracic – backward (kyphoses). These bends appeared as a result of adaptation to the vertical position of the body. They turn the spine into a kind of spring and allow it to carry a variety of dynamic and static loads without harm. The bending angles are normally 20-40 degrees. The spine consists of many separate bones (vertebrae), between which elastic intervertebral discs are located. Vertebrae consist of a body, an arch and processes. The massive body takes on the load, the bow is involved in the formation of the spinal canal, and the processes connect the vertebrae to each other.
Normally, the vertebral bodies have an almost rectangular shape, their posterior and anterior sections are approximately equal in height. In Scheuermann disease, several thoracic vertebrae decrease in height in the anterior sections, acquire a wedge-shaped shape. The angle of the pectoral bend increases to 45-75 degrees. The back becomes round. The load on the spine is redistributed. The intervertebral disc tissue “pushes through” the closure plate and protrudes into the body of the lower or overlying vertebra, Schmorl hernias are formed. The ligaments holding the vertebrae thicken compensatorily, which further complicates the recovery and further normal growth of the vertebrae. The shape of the chest changes, which can lead to compression of internal organs.
Classification
In traumatology and orthopedics, the following stages of Scheuermann disease are distinguished:
- Latent. Children aged 8-14 years suffer. The symptoms are erased. At rest, the pain syndrome is absent or weakly expressed. There may be unpleasant sensations or non-intense back pain after exertion. Gradually progressive deformation of the spine prevails. Examination reveals an increase in the angle of thoracic kyphosis or a flat back with an overly pronounced lumbar lordosis. There may be a slight limitation of mobility – leaning forward, the patient cannot reach the feet with outstretched hands. Excessive kyphosis does not disappear even when trying to straighten your back as much as possible.
- Early. It is observed in patients 15-20 years old. They are concerned about periodic or constant pain in the lower thoracic or lumbar spine. Sometimes herniated discs are formed. In some cases, spinal cord compression may occur.
- Late. It is detected in patients older than 20 years. Osteochondrosis, hernias, deforming spondylosis, spondyloarthrosis and ossifying ligamentosis develop. A dystrophic lesion of the spine often causes compression of nerve roots, as a result of which sensitivity and movement in the extremities may be impaired.
Taking into account the level of lesion , there are:
- Chest shape. The lesion of the lower and middle thoracic vertebrae is revealed.
- Lumbar-thoracic shape. The upper lumbar and lower thoracic vertebrae are affected.
Scheuermann disease symptoms
The first manifestations of Scheuermann disease appear during puberty. As a rule, the patient does not complain during this period. Pathology is discovered by chance when parents notice that the child has begun to slouch and his posture has deteriorated. Around this time, the patient begins to notice unpleasant sensations in the back that occur after a prolonged stay in a sitting position. Sometimes there are non-intense pain between the shoulder blades. The mobility of the spine is gradually limited.
Over time, spinal deformity becomes more and more noticeable. There is a pronounced stoop, in severe cases a hump is formed. The intensity of the pain syndrome increases, the child notes the constant severity and rapid fatigue of the back during exercise. The pain increases in the evening and when lifting weights. With a significant curvature of the spine, lung and heart functions may be impaired. In some cases, there is subacute or acute compression of the spinal cord, accompanied by paresthesia, impaired sensitivity and limb movements.
Diagnostics
The doctor interviews a patient with suspected Scheuermann disease, finding out complaints, the history of pathology and family history (whether there were cases of the disease in the family). The leading method of instrumental diagnostics is radiography of the spine. Radiographs show a characteristic pattern: an increase in the angle of thoracic kyphosis of more than 45 degrees, wedge-shaped deformation of three or more thoracic vertebrae and Schmorl hernia. To identify neurological disorders, a neurologist’s consultation is prescribed. In the presence of such disorders, the patient is referred for MRI of the spine and CT of the spine for a more accurate assessment of the condition of bone and soft tissue structures. Electromyography may also be prescribed. Intervertebral hernia is an indication for consultation with a neurosurgeon. If you suspect a violation of the function of the chest organs, you need to consult a pulmonologist and a cardiologist.
Scheuermann disease treatment
Orthopedists and vertebrologists are engaged in treatment. Therapy is long-term, complex, includes physical therapy, massage and physiotherapy activities. At the same time, special therapeutic gymnastics is crucial in restoring normal posture. During the first 2-3 months, exercises should be done daily, then every other day. Performing a set of exercises takes from 40 minutes to 1.5 hours. It must be remembered that with irregular classes, the therapeutic effect decreases sharply.
Physical therapy to eliminate kyphosis and restore posture includes 5 blocks: strengthening the muscles of the thoracic spine, strengthening the muscles of the buttocks, relaxing the muscles of the lower back and neck (with kyphosis, these muscles are constantly in a state of increased tone), stretching the pectoral muscles, breathing exercises. Regular physical education is also useful, but physical activity should be purposeful, thoughtful, taking into account contraindications and possible consequences.
So, with Scheuermann disease, classes with weights of more than 3 kg for women and more than 5 kg for men are contraindicated. It is not recommended to pump up the pectoral muscles, as they begin to “pull” the shoulders forward. It is impossible to engage in “jumping” sports (basketball, volleyball, long jump, etc.), since an intense simultaneous load on the spine can provoke the formation of Schmorl hernias. Swimming is useful with the right technique (when the muscles of not only the chest, but also the back are involved), so it’s better to take a few lessons from an instructor.
A good result is provided by a professional massage. It improves blood circulation in the muscles of the back, activates the metabolism in the muscle tissue and makes the muscles more plastic. Patients with kyphosis are recommended to undergo at least 2 massage courses lasting 8-10 sessions annually. A similar therapeutic effect is observed in therapeutic mud. Mud therapy courses are also conducted 2 times a year, one course consists of 15-20 procedures.
In addition, patients with Scheuermann disease are recommended to choose the right furniture for work, sleep and rest. Sometimes it is necessary to wear a corset. Medication is usually not required. Taking drugs to strengthen the skeleton (calcitonin) is indicated in extreme cases – with pronounced deformation of the vertebrae and large Schmorl hernias. It should be borne in mind that such drugs have a fairly large list of contraindications (including by age), can provoke calcification of ligaments and the formation of kidney stones, so they should be taken only as prescribed by a doctor.
Indications for surgical interventions in Scheuermann disease are a kyphosis angle of more than 75 degrees, persistent pain, respiratory and circulatory disorders. During the operation, metal structures (screws, hooks) are implanted into the vertebrae, allowing the spine to be aligned with the help of special rods.
Literature
- Scheuermann’s Disease in Young Adults: A Case Report. Jain A, Saoji A. Cureus. 2022 Nov 22;14(11):e31803. link
- Classical Scheuermann disease in male monozygotic twins: further support for the genetic etiology hypothesis. Graat HC, van Rhijn LW, Schrander-Stumpel CT, van Ooij A. Spine (Phila Pa 1976). 2002 Nov 15;27(22):E485-7. link
- Adult Scheuermann kyphosis: evaluation, management, and new developments. Wood KB, Melikian R, Villamil F. J Am Acad Orthop Surg. 2012 Feb;20(2):113-21. link
- Scheuermann’s thoracic kyphosis in the adolescent patient. Hart ES, Merlin G, Harisiades J, Grottkau BE. Orthop Nurs. 2010 Nov-Dec;29(6):365-71; quiz 372-3. link
- Scheuermann kyphosis in nonhuman primates. Farrell BM, Kuo CC, Tang JA, Phan S, Buckley JM, Kondrashov DG. Spine (Phila Pa 1976). 2012 Nov 1;37(23):E1432-7. link