Scheuermann Disease Workup

Updated: Sep 08, 2020
  • Author: Jozef E Nowak, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Workup

Laboratory Studies

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

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Imaging Studies

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  • Lateral radiography of the spine demonstrates diagnostic changes in Scheuermann's disease. [3, 4] See the image below.

    • 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.)

      Preoperative lateral of a patient with an 85º thor Preoperative lateral of a patient with an 85º thoracic deformity secondary to Scheuermann's disease.
  • 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 three consecutive vertebrae

A study by Ristolainen et al found that, compared with controls, patients with Scheuermann’s disease demonstrated, on lumbar magnetic resonance imaging (MRI), a greater prevalence of Modic changes at levels L1/L2, L3/L4, and L5/S1, with such imaging also showing Schmorl nodes to be more prevalent than in controls (64% vs 8%, respectively). In addition, MRI revealed the dura sac to be larger in Scheuermann’s disease (mean 201 mm2 vs 152 mm2). [20]

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Histologic Findings

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  • 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.

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