BRIEF DISCUSSION

KASTURBA MEDICAL COLLEGE

Scheuermann's Disease
MODERATORS:
DR.K.G.KAMATH
DR.RONALD.M
PRESENTED BY:
DR.PRAVEEN PATIL
DT: 30-06-09

Synonyms:
1.
2.
3.
4.
5.

Scheuermann disease
Juvenile kyphosis
Scheuermann kyphosis
Shermanns disease
Humpbacks disease

Introduction
Scheuermann's disease is one of the

osteochondroses affecting the thoracic or

thoracolumbar spine in adolescents, causing
increased kyphosis, poor posture and possible
backache.
It is the most common cause of structural
kyphosis in adolescents.

Pathophysiology
There is a defect in the secondary ossification

centres of the vertebral bodies. A few

vertebral bodies may be involved or the whole
thoracolumbar spine.
Hereditary factors:Autosomal dominant.
Increased levels of growth hormone.
Mechanical factors and trauma have also
been cited as possible causes.

Classification
Typical:
1. Usually involves thoracic spine.
2. Involves > 3 consecutive vertebrae,each

wedged > 5 degrees

.Atypical:
1. Usually involves thoraco-lumbar spine.
2. Characterised by vertebral endplate

changes,disc space narrowing and anterior

schmorl nodes.

Clinical features
Age:13-16 years.
Sex: more commonly in boys.
Poor posture with increased kyphosis.
Pain is a more common presentation if the

disease affects the lumbar spine. Pain is

usually worse on activity.
Neurological symptoms may rarely be the
presenting feature.
Cardiorespiratory symptoms can also rarely
occur.

Examination

Examination
Kyphosis > 40 degrees
Kyphotic deformity may be progressive.
Upper thoracic kyphosis is best seen in the

forward flexed position.

Lower thoracic kyphosis may be seen at the
thoracolumbar junction.

Examination
There is reduced flexibility of the spine.
There may be tenderness above and below

the apex of the kyphosis.

Scoliosis may also be present and is
associated with Scheuermann's disease.

Investigations
AP and lateral views of the whole
thoraco-lumbar spine

Investigations

Anterior wedging > 5 degrees or more in at

least 3 adjacent vertebral bodies
(pathognomonic for Scheuermann's disease)
Hyperkyphosis (> 40 degrees)
Narrow intervertebral disc spaces
Irregular upper and lower vertebral endplates
Schmorl nodes.

IMAGING

IMAGING:

Management
Nonoperative treatment:
Mild disease:
1. Avoidance of strenuous activity and weightbearing.
2. Physiotherapy.
3. NSAIDS.
Severe disease:
4. Casting, spinal braces (a Milwaukee brace)
5. bed rest

Nonoperative treatment:
Milwaukees
brace

TLSO brace

Operative management:
Indications:
1. Neurological deficit,
2. Uncontrolled pain,
3. Unacceptable cosmetic appearance,
4. Progression.

Operative management:
Cord decompression-neurological deficit
Spinal fusion techniques - kyphosis correction

pain control.

Operative management:

Complications
1.
2.
3.
4.

Chronic backache
Progressive and permanent deformity
Neurological deficit
Cardiorespiratory problems

Prognosis
Depends on the degree of deformity.
Mild to moderate disease rarely requires

bracing or surgery.
A gradual loss of correction can occur after a
brace is removed.
Neurological and cardiorespiratory
complication risks are very low.
Adolescents with severe deformity and
symptoms have had significant deformity
correction after surgery.

THANK YOU