Scheuermann’s disease, also known as Scheuermann’s kyphosis, often goes undiagnosed at onset. This skeletal disease only affects about five percent of the population, and first appears during adolescence. The exact reasons for its development are unknown, but experts believe it is due primarily to a growth abnormality caused by osteochondrosis, a group of disorders that affect growing bones. Diagnosis of Scheuermann's disease usually follows complaints of persistent back pain. The condition affects males more than females, but once the child stops growing, symptoms usually subside, and the spine goes back to its original shape.
Research indicates abnormal bone growth due to interruptions in blood flow cause Scheuermann's disease. The disease generally appears just before puberty, during periods of growth, but adults can develop symptoms as well. Scheuermann’s affects the thoracic spine, the area between the shoulder blades. Characteristics of the disease include excess curvature in the upper back that causes hunched appearance. Instead of a healthy, rectangular shape, the vertebrae in the back become triangular-shaped, which leads to an increased curve.
Osteochondrosis involves inflammation of the bones in various parts of the body during bone growth. Causes include injury, overuse of the growth plate, or abnormal development. Scheuermann’s disease describes osteochondrosis of the spine. The growth plates in the vertebrae stop growing anteriorly towards the front of the body, and but continue to grow posteriorly, toward the back of the body.
Back pain that intensifies through physical activity is the primary symptom of Scheuermann's disease. Some people also experience poor posture with rounded shoulders, but those diagnosed with Scheuermann’s are physically unable to straighten their backs. As such, a pronounced hump or kyphosis develops in the thoracic region. In most cases, the kyphosis is mild and some people show no symptoms at all. Once the body reaches maturity, the disease does not usually progress. But in a small percentage of Scheuermann’s cases, people continue to suffer chronic back pain and progressive kyphosis. About one-third of patients are also diagnosed with scoliosis.
Specific hereditary factors for Scheuermann’s disease exist, but there is some disagreement among researchers. In a 1992 study, researchers traced transmission of the disease over three generations. The twelve subjects underwent radiologic exams, as did their parents and siblings. Seven of the subjects had familial Scheuermann’s disease, while four of the remaining five subjects had chromosomal anomalies. Researchers say some cases are familial, but not all. Causes outside of genetics include hormonal imbalances, vascular abnormalities, and repetitive trauma.
If an individual has a more than 40 percent curvature of the back, the doctor will investigate the possibility of Scheuermann's disease. Neurological signs are rare, but the highest point of the curvature is tender to the touch upon examination. The doctor will take x-rays, including a standing view, a view of the thoracic area from front to the back, and a lateral view from the side. X-rays evidence of increased curvature, narrowed intervertebral spaces, wedge-shaped vertebral bodies, and small vertebral indentations called Schmorl’s nodes confirm Scheuermann's disease.
There are differences of opinion when it comes to treatment of Scheuermann's disease. Some doctors advise against any strenuous activity. Others feel intervention is necessary to prevent additional deformity, and order physical therapy to strengthen the body and relieve pain. If the curvature is in excess of 60 degrees, doctors may also prescribe a brace, as well as regular follow-up exams and x-rays. Severe forms of Scheuermann’s Disease may require surgery. However, in many cases, there is no need for treatment if the symptoms are mild and the curve is not getting worse.
Some people with Scheuermann’s disease develop complications. Chronic, radiating back pain and decreased flexibility may lead to a sedentary lifestyle. With age, there are increased risks of disc degeneration and cord compression, and some develop spinal osteoarthritis. Continued deformity of the thoracic area may occur in a small number of people, causing progressing cosmetic deformity. Cardiopulmonary symptoms are also possible due to the kyphosis and its proximity to the lungs, and severe cases can compress the digestive tract, causing related issues.
Physicians will consider surgery if the thoracic curve is greater than 75 percent, or if there is significant cosmetic deformity due to kyphosis and non-operative procedures and treatment do not ease the pain. A spinal fusion procedure can stabilize the area and correct the misalignment. Today, surgeons opt for posterior spinal fusion surgeries rather than older techniques relying on anterior-posterior spinal fusion, as the former offers higher success rates. After surgery, the medical practitioner may employ bone growth stimulators.
Scheuermann's treatment may include a back brace if the curve is less than 75 percent. This treatment may also reduce pain, as the brace moves the front-facing vertebrae to a more upright position. However, an individual must have at least one year of bone growth remaining for this treatment to work, and he or she must wear the brace every day, for one to two years in most cases. Many people see about a 50 percent improvement in spinal curviture from this treatment.
The severity of the disease determines the prognosis. Mild forms of Scheuermann’s disease seldom require any bracing therapy or surgery. In fact, most people who have the disease report no quality-of-life issues or ongoing pain. Some adults diagnosed with Scheuermann’s, who report having back pain most of their lives, are unaware they have the disease until an older age. These days, research focuses on the use of stem cells to treat the symptoms associated with Scheuermann’s disease, osteochondrosis, and degenerative disc disease.
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