Scheuermann disease manifests in adolescence and is slightly more common among boys. It 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 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.
Some cases are recognized during routine screening for spinal deformity at school. Lateral spinal x-rays 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 become irregular and sclerotic. Spinal misalignment is predominantly kyphotic but is sometimes partly scoliotic.
In atypical cases, generalized skeletal dysplasia must be excluded by x-ray skeletal survey, and, if suspected on clinical grounds, spinal tuberculosis must be excluded by CT or MRI.
The course is mild but long, often lasting several years (although 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 and by avoiding strenuous activity. 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.