Scheuermann disease is an osteochondrosis that causes localized changes in vertebral bodies, leading to backache and kyphosis. Diagnosis is with spinal radiographs. Treatment usually involves reduction of weight bearing and strenuous activity; rarely, surgical correction of misalignment may be needed.
Scheuermann disease refers to juvenile osteochondrosis of the spine and is characterized by structural kyphosis. It manifests in adolescence and is slightly more common among boys. In an observational study from the Netherlands, the population prevalence was reported to range between 1% and 10% (1).
Scheuermann disease probably represents a group of diseases with similar symptoms, but etiology and pathogenesis are uncertain. It may result from osteochondritis of the upper and lower cartilaginous vertebral end plates or trauma. Some cases are familial.
Most patients present with a round-shouldered posture (a hunched back), and they may have persistent low-grade backache. Some have an appearance similar to people with Marfan syndrome; trunk and limb length are disproportionate. Normal thoracic kyphosis is increased diffusely or locally.
General reference
1. Makurthou AA, Oei L, El Saddy S, et al. Scheuermann disease: evaluation of radiological criteria and population prevalence. Spine (Phila Pa 1976). 2013;38(19):1690-1694. doi:10.1097/BRS.0b013e31829ee8b7
Diagnosis of Scheuermann Disease
Radiographs
Sometimes CT or MRI
Some cases are recognized during routine screening for spinal deformities at school.
Lateral spinal radiographs confirm the diagnosis of Scheuermann disease by showing anterior wedging of ≥ 5° of 3 or more consecutive vertebral bodies, usually in the lower thoracic and upper lumbar regions. Later, the end plates may become irregular and sclerotic. Spinal misalignment is predominantly kyphotic but is sometimes partly scoliotic.
In atypical cases, generalized skeletal dysplasia must be excluded by a radiographic skeletal survey, and, if suspected on clinical grounds, spinal tuberculosis must be excluded by CT or MRI.
Treatment of Scheuermann Disease
Reducing weight bearing, strenuous activity, or both
Sometimes a spinal brace
Rarely surgery
The course is mild but long, often lasting several years (although the duration varies greatly). Trivial spinal misalignment often persists after the disorder has become quiescent.
Mild, nonprogressive disease can be treated by reducing weight-bearing stress (eg, limiting high-impact sports or heavy lifting) and by avoiding strenuous activity, which help reduce pain and prevent progression of the deformity.
Occasionally, when kyphosis is more severe, a spinal brace or rest with recumbency on a rigid bed is indicated.
Rarely, progressive cases require surgical stabilization and correction of misalignment.
