Scheuermann's Disease

Article written by Gerard Jeong, MD

WHAT IS IT?
Kyphosis (Ky-fo-sis) describes the forward bending of a particular segment of the spine when viewing a person from the side-profile. Kyphosis is normal in some segments of the spine, specifically in the thoracic spine, but abnormal in the cervical and lumbar spine. The lumbar and cervical spine normally have a backwards bend (lordosis).

Scheuermann's disease (SD) is a spinal deformity that results in greater than normal kyphosis in the thoracic spine (Type 1) or in the presence of kyphosis in the lumbar spine (Type 2). Although there are many causes of a "humpback" (kyphotic) spinal deformity such as poor posture (postural roundback), congenital abnormality, trauma, infection, or surgery, SD has a characteristic deformity that is found on physical examination and on radiographs.

HOW DOES IT HAPPEN?
The cause of SD is not completely understood. Theories include blood flow disturbances, abnormal mechanical loading, osteoporosis, and cartilage defects, all of which are postulated to result in retardation in bone growth. There does appear to be a genetic predisposition.

WHAT ARE THE SYMPTOMS?
It is typically diagnosed during juvenile age (8-12 years) through adolescence. However, many adults can and do present with SD, which was undiagnosed during childhood. Symptoms are deformity, pain, and rarely, neurological deficit leading to leg weakness or numbness. The most common symptom is the characteristic, rigid, roundback deformity. Although the risk of curve progression is not known, the fixed deformity can be cosmetically unappealing, contribute to poor posture, and lead to a dissatisfied self-image in some patients. Pain at the site of the deformity has been found in up to 50% of patients during adolescence. The exact cause of the pain- whether it is due to spinal malalignment, degenerative changes, or soft-tissue- is not completely known. Although the natural history of SD is not fully understood, studies have demonstrated that patients with untreated SD have a higher incidence of disabling, severe back (thoracic) or low back (lumbar) pain than the normal population.

HOW IS IT DIAGNOSED?
Specific radiographic changes are found in SD which differentiate it from other causes. These include 1) kyphosis greater than 50-degrees, 2) abnormal vertebral body wedging greater than 5-degrees at three adjacent vertebra, and 3) vertebral endplate irregularities.

WHAT IS THE TREATMENT?
Initial treatment includes physical therapy and pain medications if necessary. Bracing may be effective in patients who have not reached skeletal maturity. In some cases, spinal surgery may be indicated to correct and stabilize large, rigid curves and/or to provide relief or reduction of pain that has been unresponsive to nonsurgical treatment. If you have symptoms similar to the description of SD or have been diagnosed with SD, please consult your spine doctor to discuss your available treatment options.