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Scheuermann Disease
Updated: Apr 2, 2009
Introduction
Background
Scheuermann, or Scheuermann's, disease (juvenile kyphosis) is a deformity in the thoracic or thoracolumbar spine in children. Patients have an increased kyphosis in the thoracic or thoracolumbar spine with associated backache and localized changes in the vertebral bodies. (See image below and Image 1.)
Preoperative lateral of a patient with an 85º thoracic deformity secondary to Scheuermann's disease.
Pathophysiology
Scheuermann's disease refers to osteochondrosis of the secondary ossification centers of the vertebral bodies. The lower dorsal and upper lumbar vertebrae are involved initially. The process may be limited to several bodies or may involve the entire dorsal and lumbar spine.
Scheuermann's disease probably is heterogeneous (ie, not a single entity but a group of conditions sharing similar features). The etiology and pathogenesis are a matter of debate. Many theories have been advanced, including mechanical, metabolic, and endocrinologic causes.
A definite hereditary component is involved in the development of the condition, but the mode of inheritance has been debated. Reports of identical radiologic changes in monozygotic twins and transmission over 3 generations suggested underlying heritability. In study by McKenzie and Sillence, 12 probands were referred, and upon radiologic examination of their parents and siblings, 7 were shown to have familial Scheuermann's disease with an autosomal dominant pattern of inheritance.1 Of the remaining 5 probands, 4 had chromosomal anomalies.
Patients with Scheuermann's disease generally are affected at age 13-16 years, are taller2 than comparably aged peers, and have advanced skeletal versus chronologic age. Some affected children have disproportionate limb lengths.
A Greek research report, however, found that although, in the study, children with Scheuermann's disease tended to be taller and weigh more than did other children, there seemed to be no correlation in children with the disease between these 2 factors and the magnitude and morphology of the main kyphotic curve.2 The authors suggested that hormonal disturbances may be impacting the development of Scheuermann's disease and also causing, as a secondary result, height and weight increases.
In a Finnish study, left-handedness was found to be a powerful determinant of hyperkyphosis in school children before puberty.3 An increased incidence of spondylolysis and spondylolisthesis also was reported in patients with Scheuermann's disease, and scoliosis in the region of kyphosis is reported in 20-30% of patients as well.4
According to some authors, the presence of an adjacent area of lordoscoliosis below the region of hyperkyphosis testifies to the common nature of the pathogenesis of idiopathic scoliosis and Scheuermann's disease. Scheuermann's disease may be associated with an epidural cyst with an ensuing neurologic deficit.
Frequency
United States
The prevalence rate of Scheuermann's disease is thought to be 0.4-8%.
International
No international data on Scheuermann's disease are available.
Mortality/Morbidity
Many authors believe that there are few adverse long-term sequelae of Scheuermann's disease, despite a paucity of available natural history data. Lowe suggests that if residual kyphosis remains less than 60 º at skeletal maturity, the patient has an excellent prognosis for minimal problems in adult life.
Pain may be present but generally ceases when growth is complete. Minimal spinal malalignment may persist when the disorder becomes quiescent. Early development of marginal osteophytes may occur. Acute myelopathy secondary to cord compression at the apex of the thoracic kyphosis has been reported.
Sex
Scheuermann's disease affects boys more frequently than it does girls.
Age
Scheuermann's disease affects children aged 13-16 years, and the diagnosis is rarely made in patients younger than 10 years.
Clinical
History
- Most patients with Scheuermann's disease present with a history of deformity. The parent brings the child to the physician because of poor posture or referral from a school screening program.
- The incidence of pain is low, although 20% of patients may complain of discomfort in the region of the kyphosis. In patients with lumbar localization of kyphosis, the pain appears more pronounced—as many as 80% may report lower back pain. The pain is usually intermittent and is characterized as dull and aching; it is related generally to activity and is relieved by rest.5
Physical
- Patients with upper thoracic Scheuermann's disease present with a kyphotic deformity best demonstrated in the forward flexed position.
- Decreased flexibility of the spine is noted, indicating the structural nature of the kyphotic deformity, in contrast to patients with flexible postural kyphosis.
- Patients may have tenderness to palpation above and below the apex of the kyphosis.
- A high association exists between scoliosis and Scheuermann's disease. Patients also may have a hyperlordosis in the lumbar spine.
- Lower thoracic kyphosis is localized at the thoracolumbar junction; in general, any kyphotic deformity present at this level must be considered abnormal.
- Hamstring tightness may be present in these patients.
- A careful neurologic examination is recommended, although neurologic deficits are extremely rare.
Causes
- Osteochondritis of the upper and lower cartilaginous vertebral plates has been incriminated in the development of Scheuermann's disease.
- Trauma sometimes seems to be a causative factor.
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 |
| Next Page » |
References
McKenzie L, Sillence D. Familial Scheuermann disease: a genetic and linkage study. J Med Genet. Jan 1992;29(1):41-5. [Medline].
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].
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].
Segatto E, Lippold C, Vegh A. Craniofacial features of children with spinal deformities. BMC Musculoskelet Disord. Dec 22 2008;9:169. [Medline]. [Full Text].
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].
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].
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].
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].
Vetrile ST, Kuleshov AA, Shvets VV, et al. [Operative treatment of severe spine deformities]. Vestn Ross Akad Med Nauk. 2008;34-40. [Medline].
Soo CL, Noble PC, Esses SI. Scheuermann kyphosis: long-term follow-up. Spine J. Jan-Feb 2002;2(1):49-56. [Medline].
Berkow R, Fletcher AJ. In: Merck Manual of Diagnosis & Therapy. 15th ed. Rahway, NJ:. Merck, Sharp & Dohme Research Laboratories;1987:2107-8.
Dandy DJ. In: Essential Orthopedics and Trauma. Edinburgh, Scotland:. Churchill Livingstone;1989:316, 424.
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].
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].
Greenfield GB. In: Radiology of Bone Diseases. 5th ed. Philadelphia, Pa:. JB Lippincott;1990:173-4.
Millner PA, Dickson RA. Idiopathic scoliosis: biomechanics and biology. Eur Spine J. 1996;5(6):362-73. [Medline].
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].
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].
Turek SL. In: Buckwalter JA, ed. Turek's Orthopaedics: Principles and Their Application. 5th ed. Philadelphia, Pa:. Lippincott-Raven;1994:467-70.
Waldis MF, Kissling RO. Evaluation and treatment of Scheuermann''s disease. Schweiz Rundsch Med Prax. Oct 30 1990;79(44):1326-33. [Medline].
Wilde PH, Upadhyay SS, Leong JC. Deterioration of operative correction in dystrophic spinal neurofibromatosis. Spine. Jun 1 1994;19(11):1264-70. [Medline].
Further Reading
Related eMedicine topics:
Idiopathic Scoliosis
Kyphosis
Scheuermann Kyphosis
Scoliosis, Idiopathic
Spinal Orthotics
Thoracic Discogenic Pain Syndrome
Clinical guidelines:
Screening for Idiopathic Scoliosis in Adolescents: Recommendation Statement
Clinical trials:
Comparative Study of Balloon Kyphoplasty and Conservative Treatment (TRAUMAA1-2-3)
Prospective Study of Scheuermann's Kyphosis (PSK)
Keywords
Scheuermann disease, Scheuermann's disease, kyphosis, scoliosis, Scheuermann's, Scheuermann's kyphosis, Scheuermann, idiopathic scoliosis, kyphotic, thoracic kyphosis, juvenile kyphosis, Scheuermann kyphosis
