Scheuermann’s disease occurs most often in the upper back, also called the thoracic spine, but occasionally develops in the lower back, or lumbar spine. When the disease is in the lumbar spine, the deformity is usually not as obvious, but the lumbar deformity usually causes greater pain, more limitation on movement, and an increased likelihood of the condition continuing into adulthood.

 

 

 

 

The gradual curves of the human spine allow the body to absorb many shocks and stresses in daily life. It’s a delicate balance, though, and if part of the spine curves too much, pain and limited mobility may result.

Such problems occur at a young age with Scheuermann’s disease, also called Scheuermann’s kyphosis. It can lead to a rounded upper back, sometimes called a hump back, in otherwise healthy adolescents. Scheuermann’s disease is among the most frequent sources of back pain in young people, with pain more likely to follow either exertion or long periods of inactivity.

Symptoms:

Symptoms generally develop between the ages of 10 and 15, a time of considerable growth in the spine. These symptoms are typical:

• Tiredness and muscle stiffness, especially after a day of sitting in class
• Redness on the skin where the curvature is most pronounced and rubs against the back of a chair
• Pain made worse by activities involving twisting, bending, or arching backward, such as when participating in gymnastics, figure skating, dancing, or other sports requiring these types of movements
• Muscle spasms or muscle cramps
• Difficulty exercising
• Back pain or backache, which may come and go
• Limited flexibility
• Tight hamstrings
• Feeling off-balance

Serious damage is rare, but it is possible for Scheuermann’s disease to develop in such a way that the spinal cord or internal organs are harmed. For example, if the lungs become compressed by severe forward posture it can lead to breathing problems.

Treatments :

Treatment for Scheuerman’s disease depends on the individual’s situation. Several factors determining the best treatment include:

• Severity of the curvature in the back
• Amount of flexibility in the area
• Whether the individual is expected to continue to grow
• Concerns about appearance
• Patient preferences

In considering treatments for Scheuermann’s disease, it’s helpful to understand the anatomy of the upper back, or thoracic spine. Human spines are designed to curve, but if the curvature reaches 45 degrees or more, it’s considered abnormal. Allowing an abnormal curvature to continue could cause considerable pain and disfigurement over time.

Observation and Bracing

A young person with a slight curvature who is still growing, shows no sign of the curvature worsening, and has mild or no pain may not require intervention. Instead, the individual could be monitored by a doctor and undergo periodic X-rays, or other tests, to track the curvature. If the curvature worsens, more active treatment would be recommended.

A patient with a more advanced curvature—but with more than a year of growth left—would typically receive more intensive treatment. A back brace would usually be prescribed. Braces can stop or reverse the extra curvature during the growing years by making the front of the vertebrae more upright, which may also reduce pain.

To be most effective, braces should be worn almost all the time, at least at first. Depending on the severity and progression of the curvature, patients may be prescribed a brace for one to two years. Braces can be helpful with curvatures of up to 75 degrees. At one time, braces were thought to be ineffective once spine growth was complete, but recent research indicates there is still a good chance of success after growth has ended.

While braces were once considered bulky and uncomfortable—and often rejected by self-conscious teens—the situation has improved considerably and braces have become less obtrusive and more lightweight. Some of these custom-molded braces can be worn undetected under clothes and allow the young person to take part in activities—including many sports.

Many doctors now recommend these kinds of braces, including the kyphologic and thoracolumbosacral (TSLO)-style Boston braces, over the older, larger Milwaukee brace.

Surgery:

Surgery is rarely needed for Scheuermann’s disease, and nonsurgical options will typically be attempted before surgery is considered.

There are certain situations in which surgery may be advised, however. It may be considered for patients with severe deformities—such as a curvature of more than 75 degrees for thoracic kyphosis, if neurological deficits are present, and occasionally if pain is caused by the deformity.

The goal of the surgery is mainly to reduce the deformity, and possibly lessen pain or neurological symptoms. Surgery will typically include:

• A front thoracotomy (approach through the chest) to release the tissues, remove the discs, and place a bone graft in the spaces to fuse the thoracic spine
• During the same surgery, the spine is then approached from the back and instrumentation, such as rods, bars, wires, or screws, to hold the spine straight during the fusion process is put in place.

After surgery, provided the fusion is successful, all the affected segments will be fused into one continuous bone that will not progress into excessive curvature, or kyphosis. Because Scheuermann’s disease usually occurs in the thoracic spine, which has almost no motion, a fusion in this area does not affect the normal motion of the spine and typically does not lead to pain later in life.