Scheuermann's disease is a self-limiting skeletal disorder of childhood.
It is also known as Scheuermann's kyphosis, Calvé disease, and idiopathic juvenile kyphosis
of the spine.
It is named after Holger Werfel Scheuermann.
Scheuermann's disease describes a condition where the vertebrae grow unevenly with respect
to the sagittal plane; that is, the posterior angle is often greater than the anterior(This
uneven growth results in the signature "wedging" shape of the vertebrae, causing kyphosis.
Presentation Scheuermann's disease is considered to be
a form of juvenile osteochondrosis of the spine.
It is found mostly in teenagers and presents a significantly worse deformity than postural
kyphosis.
Patients suffering with Scheuermann’s kyphosis cannot consciously correct their posture.
The apex of their curve, located in the thoracic vertebrae, is quite rigid.
Scheuermann's disease is notorious for causing lower and mid-level back and neck pain, which
can be severe and disabling.
The sufferer may feel pain at the apex of the curve, which can be aggravated by physical
activity and by long periods of standing or sitting; this can have a significantly detrimental
effect to their lives as their level of activity is curbed by their condition and they may
feel isolated or uneasy amongst their peers if they are children, depending on the level
of deformity.
In addition to the pain associated with Scheuermann's disease, many sufferers of the disorder have
loss of vertebral height, and depending on where the apex of the curve is, may have a
visual 'hunchback' or 'roundback'.
It has been reported that curves in the lower thoracic region cause more pain, whereas curves
in the upper region present a more visual deformity.
Nevertheless, it is typically pain or cosmetic reasons that prompt sufferers to seek help
for their condition.
In studies, kyphosis is better characterized for the thoracic spine than for the lumbar
spine.
The seventh and tenth thoracic vertebrae are most commonly affected.
It causes backache and spinal curvature.
In very serious cases it may cause internal problems and spinal cord damage, but these
cases are extremely rare.
The curvature of the back decreases height, thus putting pressure on internal organs,
wearing them out more quickly than the natural aging process; surgical procedures are almost
always recommended in this case.
Comorbid conditions Many with Scheuermann's disease often have
an excessive lordotic curve in the lumbar spine; this is the body's natural way to compensate
for the kyphotic curve above.
Interestingly, many with Scheuermann's disease have very large lung capacities and males
often have broad, barrel chests.
Most people have FVC scores above average.
It has been proposed that this is the body's natural way to compensate for a loss of breathing
depth.
Often patients have tight hamstrings, which, again, is related to the body compensating
for excessive spinal curvature, though this is also debated.
In addition to the common lordosis, it has been suggested that between 20–30% of patients
with Scheuermann's Disease also have scoliosis, though most cases are negligible.
In more serious cases, however, the combination is classified as a separate condition known
as kyphoscoliosis.
Causes The cause is not currently known, and the
condition appears to be multifactorial.
Several candidate genes have been proposed and excluded.
Conservative treatment Scheuermann's disease is self-limiting after
growth is complete, meaning that it generally runs its course and never presents further
complication.
Typically, however, once the patient is fully grown, the bones will maintain the deformity.
For this reason, there are many treatment methods and options available that aim to
correct the kyphosis while the spine is still growing, and especially aim to prevent it
from worsening.
While there is no explanation for what causes Scheuermann's Disease, there are ways to treat
it.
For decades there has been a lot of controversy surrounding treatment options.
For less extreme cases, manual medicine, physical therapy and/or back braces can help reverse
or stop the kyphosis before it does become severe.
Because the disease is often benign, and because back surgery includes many risks, surgery
is usually considered a last resort for patients.
In severe or extreme cases, patients may be treated through an extensive surgical procedure
in an effort to prevent the disease from worsening or harming the body.
In Germany, a standard treatment for both Scheuermann's disease and lumbar kyphosis
is the Schroth method, a system of specialized physical therapy for scoliosis and related
spinal deformities.
The method has been shown to reduce pain and decrease kyphotic angle significantly during
an inpatient treatment program.
Surgery
Scheuermann's disease can be successfully corrected with surgical procedures, almost
all of which include spinal fusion and hardware instrumentation, i.e., rods, pedicle screws,
etc.
While many patients are typically interested in getting surgery for their correction, it
is important to realize the surgery aims to reduce pain, and not cosmetic defect.
As always, surgical intervention should be used as a last resort once conservative treatment
fails or the patient's health is in imminent danger as any surgical procedure is not without
risk; however, the chances of complication are relatively low and the surgeries are often
successful.
One of the largest debates surrounding Scheuermann's disease correction is the use of very different
correction procedures.
There are different techniques to correct kyphosis; usually the differences being posterior/anterior
entry or posterior entry only.
The classic surgical procedure partially entails entering two titanium rods, each roughly one
and a half feet long, into the back on either side of the spine.
Eight titanium screws and hardware are drilled through the bone and secure the rods onto
either side of the spine.
On the internal-facing side of the spine, ligaments must be surgically cut or released,
not only stopping part of the cause of the kyphosis, but also allowing the titanium rods
to pull the spine into a more natural position.
Normally, the damaged discs between the troubled vertebrae are removed and replaced with cartilage
from the hip or other parts of the vertebrae, which once healed or 'fused' will solidify.
The titanium instrumentation holds everything in place during healing and is not necessary
once fusion completes.
Recovery begins in the hospital and depending on whether the operation is one- or two-stage
the patient can expect to be in hospital for minimum of a week, possibly longer depending
on recovery.
They will then often be required to wear a brace for several months to ensure the spine
heals correctly leaving the patient with the correct posture.
The titanium instrumentation can stay in the body permanently, or be removed years later.
Patients undergoing surgery for Scheuermann's disease often need physical therapy to manage
pain and mobility, however their range of motion is generally not limited very much.
Recovery from kyphosis correction surgery can be very long; typically patients are not
allowed to lift anything above 5 or 10 pounds for 6 months to a year.
Many are out of work for at least 6 months.
However, once the fusion is solidified, most patients can return to their usual lifestyle
within one to two years.
Prognosis Spinal fusion for kyphosis and scoliosis is
an extremely invasive surgery.
The risk of complications is estimated to be about 10%.
Possible complications may be inflammation of the soft tissue or deep inflammatory processes,
breathing impairments, bleeding and nerve injuries.
As early as five years after surgery around 5% require reoperation and long-term issues
remain unclear.
Taking into account that signs and symptoms of spinal deformity cannot be changed by surgical
intervention, surgery remains to be a cosmetic indication, though the cosmetic effects of
surgery are not necessarily stable.
Notable people with the condition Milan Lucic, NHL hockey player for the Boston
Bruins George Sampson, winner of the second series
of Britain's Got Talent Şehzade Cihangir, son of Suleiman the Magnificent
and Hurrem References
External links
http:orthoinfo.aaos.orgthr_report.cfm?Thread_ID=247&topcategory=Spine http:www.back.com/causes-developmental-scheuermann.html
http:www.emedicine.comtopic129.htm Scheuermann's Kyphosis: Abnormal Curvature
of the Spine http:www.allaboutbackandneckpain.comspinesub.asp?id=27