Scheuermann's
disease is a developmental disorder that causes patients to have a stooped forward
or bent-over posture as a result of excessive kyphosis of the thoracic spine.
This condition affects between 0.5% and 8% of the general population, and is more
common in boys than in girls. Scheuermann's disease is caused by more than bad
posture, and there are several clinical and radiographic findings that are typical
in this disease that help to differentiate Scheuermann's kyphosis from postural
kyphosis.
 The above illustration shows a patient with postural kyphosis. When he bends forward, his spine
forms a smooth curve. Patients with postural kyphosis can generally correct the
kyphosis by making a conscious effort to do so.
This illustration shows a patient with structural kyphosis. When he bends forward, the angular
gibbus can be seen. The patient cannot consciously correct his posture.
Doctors believe that irregularities in the endplates of the vertebral bodies can prevent the anterior part of the vertebral body from growing normally, which
results in vertebral body wedging and produces a kyphotic curve that can be
quite rigid. The apex of the curve is usually located in the upper thoracic
spine, and X-rays of the spine often demonstrate the characteristic vertebral
body wedging,
endplate abnormalities, and Schmorl's nodes that are present in this disease.
In contrast, a patient who is stooped forward and has excessive thoracic kyphosis
as a result of bad posture will have none of these radiographic findings.
 Patient position for hyperextension X-ray film. A bolster is placed under the
apex of the curve to allow it to bend out as much as possible, and a lateral
X-ray is taken.
Diagnosis
The diagnosis of Scheuermann's disease is made on the basis of a physical examination
and radiographs of the spine. A physical examination is used to determine where
the apex of the curve is located, where the patient is experiencing back pain,
how flexible the curve is, and whether or not there are any other related findings.
Currently, the most commonly accepted criteria for the radiographic diagnosis
of Scheuermann's disease is the presence of at least 5 degrees of vertebral
body wedging over three adjacent levels. Radiographs are also used to determine
more precisely the relative percent correction that is possible by attempting
to reverse the kyphotic curve with a bolster or a pillow placed at the apex
of the curve while the patient is lying down.
 Treatment
The treatment of Scheuermann's disease depends upon several factors, including
the age of the patient, the severity of the curve, the presence or absence of
back pain, and whether or not the lungs are developing and functioning normally.
If a patient is young, has a mild curve, no back pain, and normal pulmonary
function, then continued observation by a doctor is usually prescribed, with
repeat clinical examinations and radiographs at regular intervals (often every
year). Many doctors will advise patients with kyphosis to participate in activities
that strengthen the muscles that support the spine, stretch the hamstrings,
and improve cardiovascular fitness. This type of therapy is considered an important
part of ensuring the curve stays as flexible as possible, and that the muscles
of the back are as strong as possible in an effort to prevent further progression.
Other forms of treatment, including bracing and surgery, are considered when
there is a rapid increase in the size of the curve; worsening of the vertebral
body wedging, back pain that will not improve with conservative measures, and
difficulties with pulmonary function that are related to the kyphotic deformity.
The decision about when and how to brace the spine of a patient with Scheuermann's
disease, or to perform surgery, is made on an individual basis. Your doctor
will be able to explain all of the options for the treatment of this disease
if conservative measures are no longer working.
Click here to find a doctor who treats Scheuermann's kyphosis.
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| Published: February 21, 2008 |
Updated: February 21, 2008 |
|
