Scheuemann's

Scheuermann’s disease is a poorly defined condition. It presents mostly in teenagers below skeletal maturity as a significant structural deformity of thoracic kyphosis.

Cause

The cause is unknown, but is considered to be a form of juvenile osteochondrosis of the spine. There may be a genetic component contributing to the condition (Graat et al, 2002). The individual vertebrae grow unevenly in the saggital plane, resulting in an anterior wedging of the vertebrae causing a kyphosis of more than 40°. The 7th and 10th thoracic vertebrae are most commonly affected (Saada et al, 2000).

Prevalence

Estimated prevalence is variable between 0.4% and 10% (Moquin et al, 2003).

Presentation

Scheuermann’s disease can cause lower and mid-level back and neck pain. The patient may feel pain at the apex of the curve, aggravated by physical activity and periods of standing or sitting. In addition to pain, many patients have loss of vertebral height, and may have an accentuated kyphosis. Lower thoracic kyphosis may cause more pain, whereas upper thoracic kyphosis may present a more visual deformity. In very serious cases it may cause visceral symptoms and spinal cord compression, but these are extremely rare (Summers et al, 2008).

Patients with Scheuermann’s disease cannot consciously correct their kyphosis deformity. Associated pain may reduce when the person reaches skeletal maturity (Saada et al,2000).

The diagnosis of Scheuermann’s disease is made through imaging.

First, consider supported self management (SSM) and review conservative treatment options

Link to exit/redirection and health improvement.

Long term

Natural History and Timeframes

No information available within the literature.

Treatment Options

Early diagnosis and intervention is beneficial.

The aims of conservative treatment of Scheuermann’s disease are:

• To prevent or treat spinal pain
• To improve aesthetics via postural correction (Negrini et al, 2012)
• To stop curve progression
• To prevent or treat respiratory dysfunction

Progressing as expected (up to 3 Rxs) before discharge or onward referral.

Consider general progression/escalation advice.

Onward Referral

There is no city-wide pathway for onward referral of these patients.

Assessment through orthopaedics or rheumatology may be appropriate if the patient is under skeletal maturity with undiagnosed Scheuermann’s disease with:

• Obvious kyphotic deformity
• Associated symptoms of radiculopathy not resolving with physiotherapy
• Associated symptoms of myelopathy
• Severe pain and functional restriction as a direct result of the deformity

Evidence

Graat, H.C.A., van Rhijn, L.W., Schrander-Stumpel, C.T.R.M. and van Ooij. 2002. Classical scheurrman’s disease in male monzygotic twims. Spine, 27: 485-487 Link Here (link as correct as of 13/12/19). NHS Scotland Athens username and password may be required.

Monticone, M., Ambrosini, E., Cazzaniga, D., Rocca, B. and Ferrante, S. 2014. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. European Spine Journal 23(6):1204-14. Link Here (link correct as of 13/12/19). NHS Scotland Athens username and password may be required.

Moquin R.R., Rosner M.K. and Cooper P.B. 2003. Combined anterior-posterior fusion with laterally placed threaded interbody cages and pedicle screws for Scheuermanns Kyphosis, Neurosurgical Focus, 14: 1-5 Link Here (link correct as of 13/12/19). NHS Scotland Athens username and password may be required.

Negrini, S., Aulisa, A.G., Aulisa, L., Circo, A.B., de Mauroy, J.C,, Durmala, J., Grivas, T.B., Knott, P., Kotwicki, T., Maruyama, T., Minozzi, S., O'Brien, J.P,, Papadopoulos, D., Rigo, M., Rivard, C.H., Romano, M., Wynne, J.H., Villagrasa, M., Weiss, H.R. and Zaina, F. 2012. SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012 Jan 20;7(1) doi: 10.1186/1748-7161-7-3 Link Here (link correct as of 13/12/19). NHS Scotland Athens username and password may be required.

Romano, M., Minozzi, S., Bettany-Saltikov, J., Zaina, F., Chockalingam, N., Kotwicki, T., Maier-Hennes, A. and Negrini. S. 2012. Exercises for adolescent idiopathic scoliosis. Cochrane Database Systematic Review. 2012 Aug15;8:CD007837. doi: 10.1002/14651858.CD007837.pub2. Link Here for abstract (link correct as of 13/12/19). NHS Scotland Athens username and password may be required.

Saada, J., Song, S. and Briedahl, W.H., 2000. Developmental abnormalities of the thoracic region. In Giles LGF, Singer KP Clinical Anatomy and Management of Thoracic Spine Pain. Butterworth Heinmann, Oxford.

Summers, B.N., Singh, J.P., Manns, R. A., 2008. The radiological reporting of lumbar Scheuermann's disease: An unnecessary source of confusion amongst clinicians and patients, The British Journal of Radiology, 81: 383 – 385 Link Here (link correct as of 13/12/19). NHS Scotland Athens username and password may be required.