What is Scheuermann's Disease?
Very Basic Spinal Anatomy 101
The human spine has 4 basic sections:
The bones of the spine are called “vertebrae”. These vertebrae stack upon each in an interlocking manner and help protect the spinal cord. The top and the bottom of each vertebra are called the “vertebral end plates”. In between each vertebra are “discs” made up of a hard outer shell and a soft inner core. The discs act like small shock absorbers and help hold the vertebrae together.
As seen above, a normal spine has
This structure helps maintain proper body weight distribution and helps the body absorb the pounding and exertion from performing day-to-day activities.
Scheuermann’s Disease was first researched by Holger Scheuermann, a Danish orthopedic surgeon, in the 1920’s. It is characterized by a “humpback” appearance and attributed to uneven growth of a person’s spinal vertebrae. It is believed to affect anywhere from .4% to 8% of the population and typically first presents itself in adolescents and teenagers.
Symptoms and Diagnosis
Disease can be diagnosed at any time in a person’s life: childhood, adolescence,
As a child, SD is usually identified by parents or teachers who notice a hunched posture originating in the middle, or thoracic region, of a child’s back.
Adolescents with SD usually seek medical treatment due to back pain. In addition, a high percentage these patients tend to be more active males involved in sports, heavy lifting, and may also involve sudden growth spurts during puberty.
The precursor for an adult seeing a physician is usually decreased mobility due to worsening back pain. However, the later in life the diagnosis, the higher the chance for debilitating mobility issues over time.
In order for a doctor to diagnose SD, a person must undergo a battery of tests, some of which may include:
Once the tests are read by the physician, a diagnosis of SD can include one or all of the following results:
Scheuermann’s Disease is believed to be caused by an abnormality in vertebral bone growth, potentially by an interruption of blood flow to the vertebrae during adolescence (in periods of bone growth). As a result of these vascular abnormalities, the front (anterior) of the vertebrae grows faster than the back (posterior). This can cause the vertebral bodies to change from a healthy rectangular shape to triangular wedge shapes.
Other factors involved in this abnormal vertebral bone growth may include childhood osteoporosis and mechanical factors (heavy lifting, poor posture). Likely, there will be a combination of factors that comprise the root cause of the disease with mechanical factors only contributing to the severity of the disorder.
People diagnosed with SD tend to have certain physical characteristics that manifest as a result of the disease, or are seen in patients as precursors to a diagnosis. These bodily traits may include:
In addition, SD may be a predictor for adults developing severe thoracic and/or low back pain later in life. SD can result in a spinal degenerative process that causes significant interference in daily activities, due to pain and restriction of movement if left untreated. The disease may also cause ancillary problems involving the spine, including:
o This stenosis can cause myelopathy, where a patient’s balance, muscle strength, and/or nerve reactivity may be permanently affected.
Treatment plans for patients diagnosed with SD depend on a number of factors, like patient age at the time of diagnosis, the degree of deformity, and relative overall health.
If SD is confirmed during pre-pubescent or adolescent years (prior to the finalization of spinal formation), then physical therapy may be sufficient to correct a portion of the deformity. Plans may include exercises to strengthen the muscles supporting the spine, stretching of hamstring and pectoral muscles, as well as limiting physical activities that involve constant pounding of the body.
Braces that support the spine are an option in situations where physical therapy is insufficient to correct a high percentage of the deformities. Multiple studies have been published on the use of braces to help correct SD in pre-adult patients, and they vary in noting their effectiveness. There are primarily two types of braces used to help correct SD:
Milwaukee Brace is usually prescribed to be worn during waking hours but often
times can be removed for bathing.
studies note that there was marked improvement of curvature, ranging from 35%
to 50% correction, following the use of the brace.
On a side note, it is somewhat cumbersome and not cosmetically acceptable for many patients (think puberty and adolescence) so practical uses of the device vary by individual.
are very limited case-studies and detailed reports on the long-term
effectiveness of a Kyphologic Brace for treating Scheuermann’s Disease.
short-term studies have shown that the average curvature correction varies,
between 15% and 16.5%.
the effectiveness of any treatment, including physical therapy and bracing,
depends on the level of deformity and an individual’s specific
Unfortunately, once a person’s spine forms (at about the age of 14 or 15), these bracing therapies will more than likely be ineffective.
patients with Scheuermann’s Disease rarely require surgery to correct
curvatures. However, older patients
(whose spines have completed their growth cycle) who have their daily lives
interrupted by pain and limited mobility may benefit from corrective spinal
Multiple surgical procedures exist that are designed to correct deformities, improve function, and reduce back and limb pain. Some of these surgical options may include:
Each vertebra has two laminae, or bony appendages, that direct nerves to other parts of the body from the spinal cord. If these laminae become smaller, compression on the nerves result. This can cause pain, numbness, the sensation of “pins and needles”, or loss of movement. It can also be a painful surgery with long recovery periods.
The fusion can involve one or all of the spinal regions; sacral, lumbar, thoracic, and cervical. It can be performed via the front (anterior), back (posterior), or both sides (combined) of the spine.
A doctor (orthopedic spinal surgeon or neurosurgeon) will make the necessary incision and apply pressure in an attempt to straighten the curvature.
Rods and screws are then inserted into the necessary vertebrae for support and strength.
Bone tissue (from cadavers or grafts taken from the patient’s rib or pelvis) is then laid upon the spine. The bone can be ground and applied to fill gaps, or fragments can be tamped into place.
Bone Morphogenic Protein (BMP) may be used in lieu of, or in addition to, these bone grafts. BMP is a naturally occurring protein developed through gene research that aids in bone fusion. It can also be used in situations where a patient’s body is unable to fuse with cadaver bones or there is insufficient material to use from the patient’s own skeleton.
The healing time from spinal fusion will vary by individual, but multiple studies have shown very good success rates in helping maintain or improve the quality of life for patients.
**Patients will be required to wear a brace following any type of spinal fusion. Below are examples of various types of spinal braces that I have worn:
Cervical collar with thoracic extension
***Having worn these braces multiple times, here are some helpful tips
- Wash pads with shampoo and let dry for two days before wearing.
- Place the pads on an electric/gas dryer screen (used for shoes or sweaters) to help dry if necessary.
- Expect to get frustrated wearing the collar, they are tough to get accustomed to.
- Cut the tags off the back of shirts or wear tagless shirts when possible. This will help reduce itching.
Summary of Diagnosis and Treatments
The quality and quantity of long-term studies involving patients with Scheuermann’s Disease are quite disappointing. Some studies note that certain neurologists, neurosurgeons, and orthopedic spinal surgeons are seeing a higher rate of negative physical implications in older patients, including:
is one point that remains worrisome in all studies:
The aforementioned physical and mental long-term difficulties associated with Scheuermann’s Disease are appearing in all types of patients, those medically treated and those who never sought medical help.
More detailed studies on the long-term effects of Scheuermann’s Disease are desperately needed. People afflicted with this disease (and their loved ones) need more accurate and timely information to properly address and prepare for life changing events.