Scheuermann’s Disease

Scheuermann's disease, or Scheuermann's Kyphosis, is a condition in which the normal round back in the upper spine (called a Kyphosis) is increased. Most people with Scheuermann's disease will have an increased round back (e.g. a hunch back or hump back) but no pain.

The name of this condition comes from Scheuermann, the person who in 1921 described changes in the vertebral endplates and disc space that can occur during development and lead to kyphosis, or round back deformity of the thoracic spine (upper back).

Two similar but different Disorders:

• Scheuermann’s disease (or Scheuermann’s Kyphosis) to describe the condition of adolescent kyphosis (Occurs in the thoracic spine).
• Juvenile disc disorder (or juvenile discogenic disorder) to describe the condition of adolescent degenerative disc disease (which usually occurs in the lumbar spine).

Scheuermann’s Kyphosis

Also called Scheuermann’s disease occurs when the front of the upper spine does not grow as fast as the back of the spine, so that the vertebrae become wedge-shaped, with the narrow part of the wedge in front. The wedge-shape of the vertebra creates an increase in the amount of normal kyphosis (front angulation of the thoracic spine).

The wedging of vertebrae in Scheuermann’s Kyphosis is most common in the thoracic spine (upper back), with the apex of the curve typically between the T7 and T9 levels of the spine. Although less common, Scheuermann’s Kyphosis may also occur in the junction between the thoracic and lumbar spine (thoracolumbar spine) or in the lumbar spine (lower back).

The cause of Scheuermann's disease is unknown, but is thought to be due to a growth abnormality of the vertebral body. The growth plate anteriorly (in the front) stops growing but the posterior part of the growth plate continues to grow. This is due to a condition known as osteochondrosis.

Scheuermann’s disease does not spread and is not really a “disease” but a condition that can arise during growth. It is more common in males and appears in adolescents usually towards the end of their growth spurt.  If the round back deformity is severe, patients are more likely to have discomfort or pain along with the deformity as they age.

Diagnosis and treatment

The normal curvature of the thoracic spine is between 20 and 50 degrees. A curvature of more than 50 degrees, where the spine has three contiguous vertebral bodies that have wedging of 5 degrees or more, constitutes Scheuermann’s disease.

Postural round back in adolescents is most often caused by posture and not by structural changes to the spine. Postural round back can be easily distinguished from Scheuermann’s Kyphosis by the fact that the deformity goes away when the patient lies down. Typically, patients with true Scheuermann’s Kyphosis need to sleep on two or three pillows at night to stay comfortable because there deformity remains when they lie down.

Most patients with Scheuermann’s also have a mild scoliosis (when the spine curves to the side). These mild scoliosis curves rarely require treatment. As with scoliosis, an X-ray is used to confirm a diagnosis of Scheuermann’s disease.

Treatment options

Treatment of Scheuermann’s disease is indicated to relieve pain, to correct an unacceptable cosmetic deformity, and to prevent potential progression or worsening of the curve. Treatment will vary depending on the size of the curve, the flexibility of the curve, the patient’s age and the patient’s preferences.

Conservative treatments

For patients with more than one year of growth left, the kyphosis can be partially reversed by wearing a brace (e.g. a Milwaukee brace). The brace can improve the curve during the growing years by restoring height to the front of the vertebral body and sometimes can reduce pain if present. Depending on the severity and progression of the curve, patients may be prescribed a brace for one to two years.

For patients who are already skeletally mature, bracing is not an effective treatment.

An exercise program, including specific strengthening and hamstring stretching exercises, may be recommended in conjunction with bracing. While exercise won’t correct the deformity, it can be helpful in alleviating back pain and fatigue.

Surgery

Surgery is rarely needed for Scheuermann’s disease. It may be considered for patients with severe deformities (e.g. more than 70 degrees for thoracic kyphosis), if neurological deficits are present, and occasionally if pain is present with the deformity. The goal of the surgery is mostly to reduce the deformity, although some feel it can lessen pain if present.

Surgery will typically include:

• A front thoracotomy (approach through the chest) to release the tissues, remove the discs, and place bone graft in the spaces to fuse the thoracic spine;
• During the same surgery, the spine is then approached from the back and instrumentation (such as rods, bars, wires, or screws, which hold the spine straight during the fusion process) is put in place.

After surgery, provided the fusion is successful, all of the affected segments will be fused into one continuous bone that will not progress into kyphosis.

Because Scheuermann’s disease usually occurs in the thoracic spine, which has almost no motion, a fusion in this area does not affect the normal motion of the spine and typically does not lead to pain later in life. Most of the motion in the spine is in the lumbar spine, and it is usually not necessary to fuse this area. This is important to avoid overstressing the other lumbar spinal segments and causing early breakdown at adjacent levels.