Scheuermann's Kyphosis
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.
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