Conditions & Treatments - Scheuermann's Disease

 

Scheuermann's disease, also referred to as juvenile kyphosis or vertebral epiphysitis, is a structural deformity characterized by anterior wedging of 5 degrees or more of three adjacent thoracic bodies (1). Scheuermann's disease occurs more often in males than females, is most diagnosed between the ages of 12 and 16, and is associated with increased levels of growth hormone (individuals with the disease are often taller than average) (2,1). The prevalence of Scheuermann's disease is thought to be between 0.4% and 8% (3).

Scheuermann's disease is likely autosomal dominant, which means that a child only needs to inherit one abnormal gene from one parent to display the disease (1). The etiologic factors and pathogenesis of the condition are unknown (1).

Clinical Manifestations
Doctors rely on both clinical examination and radiographic imaging to diagnose Scheuermann's disease. Adolescents with Scheuermann's disease are often asymptomatic (3,1). An estimated 20% of patients with Scheuermann's disease present with dull, aching, intermittent pain in the kyphotic curve, fatigue, and spinal tenderness or stiffness (3,1). Low back pain afflicts as many as 80% of patients with Scheuermann's disease (3). Patients may exhibit an exaggerated thoracic kyphosis, prominent vertebral spinous processes, tight pectoral, hamstring, and hip flexor muscles, a more pronounced anterior pelvic tilt, and a more pronounced lumbar lordotic curve (1). Imaging will reveal anteriorly wedged vertebrae, vertebral endplate narrowing, irregular vertebral endplates, and Schmorl's nodes (1).

Treatment
Treatment of Scheuermann's disease depends on the severity of the curve, the progression of the curve, the age of the patient, and the severity of the symptoms (1). If diagnosed during the adolescent years, treatment focuses on preventing the progression of the deformity and may include postural exercise, stretching, thoracic hyperextension, soft tissue and joint mobilization, traction, exercises to strengthen abdominal and gluteal muscles, and bracing (2, 1). Researchers suggest that flexible curves are a positive predictor of successful bracing outcomes (3). A 2003 study of the duPont kyphosis brace concluded that the brace needs to be donned until skeletal maturity (or at least 16 months) in order to halt disease progression or improve the curve (3). NSAIDs and temporary rest from aggravating physical activity typically alleviate pain from Scheuermann's disease (3).

If curves are severe, progressive, or cause progressive neurologic symptoms and severe pain, surgical management may be warranted (1). If a curve greater than 75 is present alongside severe pain that is unresponsive to conservative treatment, an orthopedic surgeon may perform a spinal fusion (3). Cord decompression may be indicated if neurologic deficits are present (3).

 

Last revised: October 21 2014
by Michelle Kornder, DPT

 

References
1) Goodman, C. Introduction to Pathology of the Musculoskeletal System. In: Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis, MO: Saunders Elsevier; 2009:1116.
2) Hallisy, K. The Pediatric and Adolescent Population. In: Boissonnault, W. Primary Care for the Physical Therapist Examination and Triage. 2nd ed. St. Louis, MO: Saunders Elsevier; 2011: 290.
3) Scheuermann Disease Treatment & Management. Medscape Web site. http://emedicine.medscape.com/article/311959-treatment. Updated July 28, 2014. Accessed October 20, 2014.


 

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