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All About Scheuermann's Disease

27 January 2004

Source: Emma West - Physiotherapist

Scheuermann's disease - commonly spelt Sherman's disease - (also known as juvenile kyphosis, scheuermann's kyphosis and adolescence vertebral epiphysis) is an abnormal skeletal condition which often develops during puberty. It is defined as excessive thoracic kyphosis or increased curvature of the upper back.

Cause

The cause of Scheuermann's disease remains a topic of much debate. It is thought to occur secondary to an abnormal growth of the individual vertebrae. Trauma has also been suggested as a causative factor and there have been reports of a family tendency predisposing to Scheuermann's disease.

Signs & Symtoms

Scheuermann's disease has an insidious onset, and seen most frequently in adolescents. It first becomes apparent during the teenage or young adult years. Often individuals who are diagnosed with Scheuermann's Disease are taller than their similarly aged peers. The incidence between males and females also remains a contentious issue with several reports stating vastly differing opinions.

Some of the common symptoms include:

  • Poor posture - 'hunched' appearance with rounding of the upper back (thoracic spine) and shoulders.
  • Pain - this varies between individuals. It may manifest as a generalised ache in the upper back however some people may complain of local tenderness when the spine is touched, particularly during medical examination.
  • Fatigue
  • Stiffness in spine
  • Increased lumbar lordosis - to compensate for an increased curvature in the upper spine, there may be an increased curvature in the lower back in the opposite direction.
  • Scoliosis - some individuals may also have a scoliosis on examination.

Diagnosis

Diagnosis of Scheuermann's disease is made by plain x-ray. A lateral x-ray (taken from the side) shows increased curvature of the upper back. The normal curvature of the upper back is 20-40 degrees. If the kyphosis is greater than 45 degrees it is considered to be excessive. The vertebrae are wedge-shaped with the height at the front of the bone being less than the height at the back. Other signs noted on x-ray include narrowing of the disc space between each vertebra along with defects in the vertebral end plates resulting in the upper and lower surfaces of the vertebrae not being smooth. The process may affect a few vertebrae or extend the entire thoracolumbar spine.

Treatment

Conservative treatment options are generally tried first. These may include advice regarding posture and back strengthening and stretching exercises. Swimming may also be of benefit. While these measures do not reduce the excessive curve they can help to improve flexibility and reduce pain in the back. Relative rest may also be advised depending on the level of pain, considering the type and amount of exercise undertaken. For example the individual may be advised to avoid contact sports and reduce activity where there is repetitive loading (e.g. long distance running).

In more severe cases a brace may be prescribed. The Milwaukee brace, prescribed by a doctor and fitted by an orthotist, aims to immobilise the spine and encourage the spine to grow straight. The brace is worn all the time for at least 10-12 months and then worn for a longer period of time at night only. This is very variable and depends on the age of the individual with respect to how skeletally mature the spine is and how much more growth will occur. This is generally combined with exercises.

Medications that may be of benefit serve to reduce the pain associated with Scheuermann's Disease. Analgesics (painkillers) or anti-inflammatories may be considered after consultation with a doctor.

Surgical treatment may be considered in very severe cases where the kyphosis is more than 70 degrees, there is significant pain or cosmetically the posture is unacceptable. The surgery involves the insertion of metal rods in the back and fusion of the vertebrae which aim to help straighten out the spine. This is also combin

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