What is Scheuermann Disease?
Scheuermann kyphosis, also known as Scheuermann disease, juvenile kyphosis, or juvenile disc disease, is a condition that results in excessive outward curving of the spine, also known as ‘hyperkyphosis’. This happens due to the forward slanting of three or more neighboring bones in the spine. This condition usually affects the upper part of the spine, often including the lower region too.
Teenagers, between the ages of 12 and 17, are often diagnosed with this condition when their parents notice a hunchback deformation in their posture. It can also be identified through back pain in the exaggerated curved region of the spine.
There seems to be a genetic link to this condition, even though the exact method of inheritance is not yet clear. Monozygotic (identical) twins have been found to be more likely to have this condition than dizygotic (non-identical) twins.
What Causes Scheuermann Disease?
The exact cause of Scheuermann kyphosis, a condition that causes the upper back to curve more than normal, is still unknown. However, it is believed that genes may play a role in developing this condition, though it’s not yet clear how these genes are passed down.
There is a theory, backed up by examinations of body tissues, that suggests an uneven growth process in the spine might be the cause. This irregular growth affects a part of the spine known as the “vertebral endplate” and results in the vertebrae, or the small bones that make up the spine, taking on a wedge-like shape. This odd shape can then lead to kyphosis, where the spine curves more than it should.
Risk Factors and Frequency for Scheuermann Disease
The prevalence of this health condition ranges between 1% to 8% in the United States. Typically, it’s more common in males than in females, showing a ratio of at least 2:1. Teenagers aged 12-17 years are the most likely to be diagnosed with it, while it is rarely seen in children under the age of 10.
- Type I (Classic): Only the thoracic spine is affected, specifically areas T7-T9.
- Type II: Both the thoracic and lumbar spine are affected, particularly areas T10-T12.
Signs and Symptoms of Scheuermann Disease
Teenagers often first notice the symptoms of hyperkyphosis during their early to mid-teenage years. The signs usually appear as a cosmetic or postural change that may cause some concern. They may also experience a dull, long-lasting chest pain. The discomfort tends to get worse when they are active and eases off when they rest. It’s worth noting that this chest pain usually starts spontaneously and is not triggered by a specific event.
A physical examination would show a visibly exaggerated upper-back curve that remains stiff when the person bends forward. This lack of flexibility in the back curvature further emphasizes the severity of the deformity. Additional physical signs may include increased inward curvature of the neck or lower back, a sideways spinal curve known as scoliosis, and tight hamstrings. Brain or nervous system-related problems are rare, but a complete check of the nervous system must still be done.
At each medical visit, the doctor will assess the range of motion in the patient’s spine. They will look at movement in all directions: bending forward and backward, leaning side to side, and rotating right and left. Regular x-rays or other imaging are necessary to track the amount the upper spine curve is increasing. Monitoring changes in both the spine’s range of motion and its shape help doctors select the suitable treatment plan and predict the likely course of the condition.
- Visible postural changes
- Long-lasting chest pain worse with activity
- Stiff, exaggerated upper-back curve
- Possible increased curvature of the neck or lower back
- May have a sideways spinal curve (scoliosis)
- May have tight hamstrings
Testing for Scheuermann Disease
To examine Scheuermann kyphosis, which is an increase in the normal curve of the spine, doctors use a detailed personal history, physical examination, and specific types of X-rays. The critical elements for diagnosis are seen on lateral X-rays, which are taken from the side of the body.
On these side view X-rays, doctors look for the following:
- Rigid curvature of the spine that is greater than 40 degrees
- Three or more neighboring spinal bones, referred to as vertebral bodies, each tilted forward by 5 degrees or more
Doctors measure the amount of curvature, or kyphosis, by using a method referred to as the Cobb angle. The Cobb angle is defined as follows:
- Two lines are drawn: one along the top edge of the highest tilted bone at the top of the curved area, and one along the bottom edge of the most tilted bone at the bottom of the curve
- The Cobb angle is then the angle created by the intersecting lines drawn perpendicularly (at a 90-degree) to the two initial lines
A measured Cobb angle greater than 40 degrees indicates excessive curvature or hyperkyphosis.
Doctors measure the degree of forward tilt, or anterior wedging, which uses a similar technique on the same lateral X-rays:
- Two lines are drawn from back to front: one along the top edge and one along the bottom edge of a spinal bone
- The wedge angle is the angle created at the point where these lines meet towards the front
- Three or more consecutive spinal bones tilted forward 5 degrees or more along with pronounced curvature greater than 40 degrees confirm Scheuermann’s disease
Other features often seen on these side and front view X-rays include irregular vertebral endplates, “Schmorl nodes” (small herniations of the disc into the adjacent vertebrae), loss of disc space height, sideways curvature of the spine (scoliosis), vertebrae slipping forward on another (spondylolysis or spondylolisthesis), and disc herniation.
While not typically required, an MRI might help further assess any anatomical changes or plan for surgery. A CT scan is usually not required, and there are no necessary laboratory or microscopic tissue tests needed for a Scheuermann kyphosis diagnosis.
Treatment Options for Scheuermann Disease
If you’re dealing with a mild case of Kyphosis (a curvature of the spine that causes a hunched or slouched posture), lifestyle changes like stretching, physical therapy, or taking over-the-counter pain relievers (otherwise known as NSAIDs) can actually make a big difference. These strategies are typically used when the curvature is less than 60 degrees and not causing any symptoms. Most people with this type of Kyphosis do well and don’t have any major long-term problems.
If you have Kyphosis that’s a bit more severe (a curvature between 60 and 80 degrees), wearing a specific kind of brace might be recommended in addition to lifestyle changes and pain relievers. Wearing this brace might be necessary for 12 to 24 months, especially if you’re still growing. However, the goal of the brace isn’t necessarily to fix the curvature of your spine but to prevent it from getting worse. Here are some of the types of braces that might be used: Milwaukee brace, Kyphologic brace, or a Thoracolumbosacral orthosis-style Boston brace.
For more severe cases of Kyphosis, where the curvature is greater than 75 degrees or causing severe pain, a surgery called spinal fusion may be necessary. This surgery involves making some surgical cuts to release the tight part of the spine and then using special equipment to fuse the vertebrae (the bones in your back) together. This can help to improve the shape of your spine and reduce your symptoms. However, as with any surgery, there are potential complications, so it’s important to discuss these with your doctor.
What else can Scheuermann Disease be?
The list below covers a number of medical conditions that may relate to your spine or posture:
- Postural kyphosis (a flexible posture issue)
- Hyperkyphosis due to another known disease
- Kyphosis after surgery
- Ankylosing spondylitis (a type of arthritis affecting the spine)
- Scoliosis (a sideways curve of the spine)
What to expect with Scheuermann Disease
Most patients manage to recover through non-invasive methods, as mentioned earlier. Usually, the pain in the affected area gets better after the patient has fully grown, but those with Scheuermann kyphosis, a type of abnormal backward curvature of the spine, can be more prone to chronic back pain compared to others.
Long-term follow-up studies often show that these patients may experience more back pain in adulthood and a lower quality of life related to health issues.
However, individuals with a kyphotic curve (the abnormal spinal curvature) less than 60 degrees when they reach full-growth typically do not experience long-term consequences.
Possible Complications When Diagnosed with Scheuermann Disease
Possible complications can include:
- Progressive changes in physical appearance
- Constant pain in the back
- Loss of nerve function, which could lead to pressure on the spinal cord
After the surgical operation, complications may also come up, like:
- Pseudoarthrosis (this is the most frequently reported complication)
- Persistent pain that may hinder daily activities
Recovery from Scheuermann Disease
Patients who have had surgery sometimes need to stay in the hospital a bit longer for rehabilitation. This is to help them get their strength and mobility back through specific exercises. It’s also so doctors can manage any pain they might have after the operation in a more intensive way.
Preventing Scheuermann Disease
It’s important for patients to understand the following key aspects of their recovery and ongoing health:
A stretching and strengthening program focused on extending the muscles. This can help improve flexibility and muscle strength.
A specific exercise program for stretching the hamstrings. Hamstrings are the muscles at the back of your thighs, and keeping them flexible and strong can help prevent injuries.
Understanding how to maintain proper posture and move your body correctly during everyday activities. This is critical to reduce strain on your muscles and joints and to prevent injuries.
Finally, learning the correct way to use and handle braces, if needed. A brace can be a useful tool to support an injured area, but it’s crucial to use it correctly to avoid causing more harm.
