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Scheuermann's Disease Overview
Scheuermann’s disease is a self-limiting skeletal disorder of childhood, in which the vertebrae grows unevenly with respect to the sagittal place. In this condition, the posterior angle is often greater than the anterior angle. The uneven growth results in the signature “wedging” shape of the vertebrae. This disease is named after Holger Werfel Scheuermann and it is also known as Scheuermann’s kyphosis.
The typical patient age is between 12 and 15 years with a round-shouldered appearance. In most cases, the progression in quite slow and this condition ceases as the axial skeletal maturity is achieved.
Scheuermann's Disease Relation with Thoracic & Lumbar Spine
Scheuermann’s disease (SD) is a spinal deformity that results in greater than normal kyphosis in the thoracic spine also known as Type 1 or in the presence of kyphosis in the lumbar spine called as Type 2. This condition commonly occurs in the thoracic spine (upper part of the spine). While the lumbar scheuermann’s disease occurs only in the lumbar spine (lower segments of the spine).
Symptoms, Causes & Diagnosis of Scheuermann's Disease
Most patients with this condition show little or no symptoms because this disease is often discovered in later life. The patients typically present a postural abnormality which is characterized by an increased forward curvature of the upper back (thoracic kyphosis). Some people experience restriction of movement specifically in backward bending of the thoracic spine without pain.
This postural abnormality is not correctable which means that the patient cannot fully straighten up. Some patients experience acute upper back pain, stiffness or ache during the period of rapid growth. Often the symptoms of Scheuermann’s disease are mild to moderate and an increased physical activity like slouching, forceful lifting, repetitive and prolonged lifting, contact sports and bending forward can aggravate this condition.
The increased arch in the lower back i.e. a secondary compensatory excessive lumbar lordosis are typically evident symptoms of this condition. Some patients do not experience upper back pain due to the postural changes, but instead might have shoulder, neck and lower back pain actually caused due to the postural change in the thoracic spine.
The cause of this disease is not known, but the condition tends to be multifactorial. Researchers speculate that the condition occurs due to pre-existing weakness in the vertebral end plates or the excessive external pressure applied in these areas.
Other factors that are thought to potentially contribute to the development of this spinal deformity include endocrine disorders, biomechanical factors like increased height, shortened sternum and juvenile osteoporosis.
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Often an x-ray is required to confirm the diagnosis of the Scheuermann’s disease. If an x-ray shows wedging of 5 degrees or more at the adjacent vertebrae then this condition is diagnosed. Some patients with the Scheuermann’s disease may also have a mild scoliosis, a condition where the spine curves to the side.
Scheuermann's Disease Treatment Options:
If the patient with Scheuermann’s kyphosis is an adult, then treatment includes, observation, anti-inflammatory drugs or the reconstructive surgery. The treatment options for Scheuermann’s disease vary depending on the size and flexibility of the curve, patient’s age and preference. Treating this condition will help to relieve the pain, correct the unacceptable cosmetic deformity and prevent potential progression as well as the worsening of the curve.
The patients with more than one year of growth left, this condition can be partially reversed by wearing a back brace. The back brace can improve the curve during the growing years by restoring the height to the front of the vertebrae and sometimes it can reduce the pain. Patients may be prescribed a brace for one to two years, depending on the severity and the progression of the curves.
Exercises involving strengthening and hamstring exercises are recommended in combination with bracing. Although exercises won’t help correcting the deformity, but it is helpful to alleviate the back pain and fatigue.
For patients who are already mature skeletally, the bracing is not an effective treatment.
A standard treatment for both the Scheuermann’s disease and the lumbar kyphosis is a Schroth method, which is a system of specialized physical therapy for spinal deformities.
Surgery for Scheuermann’s disease:
Surgery is usually considered as the last resort to treat the Scheuermann’s disease. Patients with severe or extreme cases (having more than 70 degrees of thoracic kyphosis), neurological deficits and occasional pain are often recommended to undergo surgery so as to prevent the disease from worsening or harming the body. The goal of the surgery is to reduce the deformity.
The surgery includes:
A front thoracotomy (surgery performed through the chest) to remove the discs, release the tissues and place the bone graft in the spaces to fuse the thoracic spine.
During the same surgery, the spine is approached from the back and the instrumentation like the bars, rods, wires, screws that hold the spine straight will be put in place.
After completion of the surgery, if the fusion is successful, then all the affected segments will be fused into one continuous bone such that it will not progress into kyphosis.
Since the Scheuermann’s disease occurs mostly in the thoracic spine that has no motion, a fusion in this area will not affect the normal motion of the spine. Also, this procedure will not cause pain in later life. Most of the motion occurs in the lumbar spine and often it is not necessary to fuse this area.