eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases
Scheuermann Disease: Treatment & Medication
Updated: Apr 2, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Rehabilitation Program
Physical Therapy
The treatment of Scheuermann's disease is controversial. Some authors think that the natural history of thoracic Scheuermann's disease is benign, and that therefore the condition needs no treatment. Whether orthotics or surgical treatments prevent any of the consequences that may occur is uncertain.
Some authors recommend treatment in the skeletally immature patient in the hope of preventing excessive deformity, which may cause pain and cosmetic concerns. Patients with mild, nonprogressive disease can be treated by reducing weight-bearing stress and avoiding strenuous activity. Exercise alone is not found to be beneficial.
When the kyphosis is more severe, recommendations include casting, a spinal brace, or rest and recumbency on a rigid bed. Orthotic management of Scheuermann's disease usually requires 12-24 months of treatment.
In a 2003 report on one type of brace for the treatment of Scheuermann's disease (evaluated at the Alfred I. duPont Hospital for Children), it was recommended that the orthosis be worn until skeletal maturity (at least 16 mo), in order to induce improvement or halt progression of the disease.8 The results for this brace were comparable to previous reports discussing the effectiveness of the modified Milwaukee brace, and the duPont kyphosis brace had the advantage of being concealable under normal attire.
Surgical Intervention
- Surgery rarely is indicated in patients with Scheuermann's disease. Probably the 2 most common indications for surgery are spinal pain and unacceptable cosmetic appearance. These criteria are subjective, so it is wise to be cautious in counseling these patients.9 (See image below and Image 2.)
- In patients with curves greater than 75° and with pain that is unresponsive to nonoperative measures, consider spinal fusion. Spinal fusion consists of an anterior release and fusion, as well as a posterior instrumentation and fusion performed under the same anesthesia on the same day.
- Cord decompression is indicated for the rare patients who have neurologic deficits secondary to epidural cysts or increased kyphotic angulation.
- The most frequently occurring complication is pseudoarthrosis, followed by instrumentation failure and secondary loss of correction.
- The optimal treatment of Scheuermann's disease is controversial. Patients treated with bracing or surgery have experienced an improved self-image, which they have attributed to their treatment. Patients with kyphotic curves extending 70° at follow-up have had an inferior functional result. Soo and colleagues suggested that by carefully selecting the appropriate treatment for patients with Scheuermann's disease on the basis of the patient's age, the spinal deformity, and the severity of back pain, achieving a similar functional result at long-term follow-up is possible.10 They felt that despite different treatment protocols, patients with Scheuermann's disease tend to achieve a similar functional result at long-term follow-up.
- Flexible curves have been suggested as a positive predictor of a successful outcome of bracing.
- Other variables that have positively influenced the outcome of treatment have been compliance with conservative treatments (a body cast plus brace and exercise regimen) and the initial presence of the Risser sign of skeletal maturity.
Postoperative lateral demonstrating a 2-rod leverage technique after an anterior release allowing reduction of the deformity to 47º.
Medication
Pain associated with Scheuermann's disease generally responds to nonsteroidal anti-inflammatory drugs (NSAIDs), as well as to temporary activity restriction.
Nonsteroidal anti-inflammatory drugs
Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.
Ibuprofen (Ibuprin, Motrin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Adult
200-400 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d
Pediatric
<6 months: Not established
6 months to 12 years: 4-10 mg/kg/dose PO tid/qid
>12 years: Administer as in adults
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, or high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy
Naproxen (Anaprox, Aleve, Naprosyn, Naprelan)
For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.
Adult
500 mg PO followed by 250 mg PO q6-8h; not to exceed 1.25 g/d
Pediatric
<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug
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 |
| « Previous Page | 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
