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Scheuermann Disease: Differential Diagnoses & Workup

Author: Jozef E Nowak, MD, Consulting/Admitting Physiatrist, Division of Physical Medicine and Rehabilitation, Kelowna General Hospital
Contributor Information and Disclosures

Updated: Apr 2, 2009

Differential Diagnoses

Other Problems to Be Considered

Postural round back (the kyphosis is flexible)
Thoracic hyperkyphosis in patients with various types of skeletal dysplasia (eg, spondyloepiphyseal dysplasia congenita, Morquio disease)
Ankylosing spondylitis may present a similar picture.
Kyphosis in patients who had a laminectomy before skeletal maturity or who had radiation to the spine for a regional tumor (eg, Wilms tumor, neuroblastoma)
Kyphosis in patients with eosinophilic granuloma
Type II congenital kyphosis (failure of segmentation)
Hyperkyphosis secondary to vertebral epiphysitis in eunuchoidism, ovarian agenesis, and Wilson disease
The possibility of scoliosis must be assessed because of the high association with Scheuermann's disease.
Friedreich ataxia and neurofibromatosis may present with hyperkyphosis and scoliosis.
Thoracic hyperkyphosis may occur secondary to glucocorticoid-induced osteoporosis in Cushing disease.
In atypical cases, a generalized skeletal dysplasia and spinal tuberculosis must be excluded.

Workup

Laboratory Studies

  • Laboratory studies are not needed in diagnosing Scheuermann's disease.

Imaging Studies

  • Lateral radiograph of the spine demonstrates diagnostic changes in Scheuermann's disease.6,7 (See image below and Image 1.)
    • Wedge-shaped vertebral bodies
    • Arcuate and rigid kyphosis
    • Narrow intervertebral disk spaces with calcifications
    • Prominent irregularities of the vertebral surfaces
    • Vertebral plates that are poorly formed and that develop multiple herniations of the nucleus pulposus known as Schmorl nodes (Note that Schmorl nodes are not uncommon and may be seen in Wilson disease, sickle cell anemia, and spinal stenosis.)
  • Sorenson suggested the following radiologic criteria for the diagnosis of Scheuermann's disease:
    • Hyperkyphosis greater than 40°
    • Irregular upper and lower vertebral endplates with loss of disk space height
    • Wedging of 5° or more in 3 consecutive vertebrae
Preoperative lateral of a patient with an 85<FONT...

Preoperative lateral of a patient with an 85º thoracic deformity secondary to Scheuermann's disease.

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Preoperative lateral of a patient with an 85<FONT...

Preoperative lateral of a patient with an 85º thoracic deformity secondary to Scheuermann's disease.


Histologic Findings

  • Histologic changes demonstrate that vertebral growth endplate cartilage is abnormal, with a decreased collagen/proteoglycan ratio on electron microscopic examination.
  • Enchondral ossification is altered profoundly in affected segments, and there are increased proteoglycan levels.
  • The matrix of the endplates is abnormal, thus interfering with normal vertebral growth.

More on Scheuermann Disease

Overview: Scheuermann Disease
Differential Diagnoses & Workup: Scheuermann Disease
Treatment & Medication: Scheuermann Disease
Follow-up: Scheuermann Disease
Multimedia: Scheuermann Disease
References
Further Reading
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References

  1. McKenzie L, Sillence D. Familial Scheuermann disease: a genetic and linkage study. J Med Genet. Jan 1992;29(1):41-5. [Medline].

  2. Fotiadis E, Kenanidis E, Samoladas E, Christodoulou A, Akritopoulos P, Akritopoulou K. Scheuermann's disease: focus on weight and height role. Eur Spine J. May 2008;17(5):673-8. [Medline].

  3. Nissinen M, Heliovaara M, Seitsamo J, et al. Left handedness and risk of thoracic hyperkyphosis in prepubertal schoolchildren. Int J Epidemiol. Dec 1995;24(6):1178-81. [Medline].

  4. Segatto E, Lippold C, Vegh A. Craniofacial features of children with spinal deformities. BMC Musculoskelet Disord. Dec 22 2008;9:169. [Medline]. [Full Text].

  5. Haveman LM, van Es HW, ten Berge-Kuipers M. [Complaints of back pain in childhood: find curable causes]. Ned Tijdschr Geneeskd. Feb 16 2008;152(7):353-8. [Medline].

  6. Summers BN, Singh JP, Manns RA. The radiological reporting of lumbar Scheuermann's disease: an unnecessary source of confusion amongst clinicians and patients. Br J Radiol. May 2008;81(965):383-5. [Medline].

  7. Bhatia NN, Chow G, Timon SJ, Watts HG. Diagnostic modalities for the evaluation of pediatric back pain: a prospective study. J Pediatr Orthop. Mar 2008;28(2):230-3. [Medline].

  8. Riddle EC, Bowen JR, Shah SA, et al. The duPont kyphosis brace for the treatment of adolescent Scheuermann kyphosis. J South Orthop Assoc. 2003;12(3):135-40. [Medline].

  9. Vetrile ST, Kuleshov AA, Shvets VV, et al. [Operative treatment of severe spine deformities]. Vestn Ross Akad Med Nauk. 2008;34-40. [Medline].

  10. Soo CL, Noble PC, Esses SI. Scheuermann kyphosis: long-term follow-up. Spine J. Jan-Feb 2002;2(1):49-56. [Medline].

  11. Berkow R, Fletcher AJ. In: Merck Manual of Diagnosis & Therapy. 15th ed. Rahway, NJ:. Merck, Sharp & Dohme Research Laboratories;1987:2107-8.

  12. Dandy DJ. In: Essential Orthopedics and Trauma. Edinburgh, Scotland:. Churchill Livingstone;1989:316, 424.

  13. Faingold R, Saigal G, Azouz EM, et al. Imaging of low back pain in children and adolescents. Semin Ultrasound CT MR. Dec 2004;25(6):490-505. [Medline].

  14. Freehill AK, Lenke LG. Severe kyphosis secondary to glucocorticoid-induced osteoporosis in a young adult with Cushing''s disease. A case report and literature review. Spine. Jan 15 1999;24(2):189-93. [Medline].

  15. Greenfield GB. In: Radiology of Bone Diseases. 5th ed. Philadelphia, Pa:. JB Lippincott;1990:173-4.

  16. Millner PA, Dickson RA. Idiopathic scoliosis: biomechanics and biology. Eur Spine J. 1996;5(6):362-73. [Medline].

  17. Platero D, Luna JD, Pedraza V. Juvenile kyphosis: effects of different variables on conservative treatment outcome. Acta Orthop Belg. Sep 1997;63(3):194-201. [Medline].

  18. Rauschmann MA, Habermann B, Engelhardt M, et al. [Pott triad and Schmorl nodules. A historical overview of kyphosis with special reference to tuberculous spondylitis and Scheuermann disease]. Orthopade. Dec 2001;30(12):903-14. [Medline].

  19. Turek SL. In: Buckwalter JA, ed. Turek's Orthopaedics: Principles and Their Application. 5th ed. Philadelphia, Pa:. Lippincott-Raven;1994:467-70.

  20. Waldis MF, Kissling RO. Evaluation and treatment of Scheuermann''s disease. Schweiz Rundsch Med Prax. Oct 30 1990;79(44):1326-33. [Medline].

  21. Wilde PH, Upadhyay SS, Leong JC. Deterioration of operative correction in dystrophic spinal neurofibromatosis. Spine. Jun 1 1994;19(11):1264-70. [Medline].

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Keywords

Scheuermann disease, Scheuermann's disease, kyphosis, scoliosis, Scheuermann's, Scheuermann's kyphosis, Scheuermann, idiopathic scoliosis, kyphotic, thoracic kyphosis, juvenile kyphosis, Scheuermann kyphosis

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Contributor Information and Disclosures

Author

Jozef E Nowak, MD, Consulting/Admitting Physiatrist, Division of Physical Medicine and Rehabilitation, Kelowna General Hospital
Jozef E Nowak, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Brain Injury Association of America, Canadian Medical Association, College of Physicians and Surgeons of Ontario, International Society of Physical and Rehabilitation Medicine, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Elizabeth A Moberg-Wolff, MD, Associate Professor and Pediatric PM&R Fellowship Director, Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin; Program Director, Tone Management and Mobility, Department of Physical Medicine and Rehabilitation, Children's Hospital of Wisconsin
Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation
Disclosure: Medtronic Neurological Grant/research funds Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching

 
 
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