What is Scheuermann disease?

Scheuermann Disease

Scheuermann disease is the most common cause of structural kyphosis in adolescence, characterized by vertebral endplate irregularity, disc space narrowing, and anterior wedging of involved vertebral bodies. 1

Definition and Pathophysiology

• Scheuermann disease is a juvenile osteochondrosis of the spine that affects the growth cartilage endplate, likely resulting from repetitive strain on growth cartilage weakened by genetic factors 2
• It is characterized by defective growth of the vertebral endplate that may result from excessive mechanical stress during spinal growth 3
• The condition has a significant genetic component with a dominant autosomal inheritance pattern with high penetrance and variable expressivity 1

Epidemiology

• Reported to occur in 0.4% to 8% of the general population with equal distribution between sexes 4
• Typically develops in late childhood to adolescence 3
• It is the most common cause of sagittal imbalance and angular progressive kyphosis in adolescents 3

Clinical Presentation

• Back pain is a common presenting symptom, though parents often confuse the condition with poor posture 4
• Clinical red flags that may warrant investigation include morning stiffness, abnormal spinal curvature, and pain lasting more than 4 weeks 5
• The condition may present as either thoracic hyperkyphosis or thoracolumbar (junctional) kyphosis 6
• Lumbar involvement is probably as frequent as the thoracic form and might be more painful 2

Diagnostic Criteria

• Radiographs are the standard imaging modality used to confirm the diagnosis 4
• Classic radiographic features include:
  • Anterior vertebral body wedging 3
  • Irregular vertebral endplates 3
  • Schmorl's nodes (intraosseous disc herniation) 2
  • Intervertebral disc degeneration 3
• Radiographs can demonstrate findings that lead to diagnosis in up to 24% of children with back pain 7

Imaging Considerations

• Initial evaluation should include radiographs of the spine targeted to the region of interest 7
• MRI may be useful for evaluating associated soft tissue and bony abnormalities, particularly if there are neurologic findings 7
• CT provides excellent bone detail and can be useful in the evaluation of suspected primary bone tumors, but does not demonstrate associated marrow edema 7
• In patients with back pain and clinical red flags, negative radiographs are not considered adequate to exclude pathology, and additional advanced imaging techniques may be required 7

Treatment Approaches

• Treatment depends on the severity of the deformity, remaining growth, and presence or absence of symptoms 4
• Conservative management is the first line of treatment:
  • Physical therapy and rehabilitation exercises are often used as the first choice, especially for mobile postural/idiopathic hyperkyphosis 6
  • Bracing appears to be more effective if diagnosed early, prior to the curvature angle exceeding 50° in patients who are still growing 1, 6
• Surgical treatment is rarely indicated and reserved for:
  • Severe kyphosis (>75°) with curve progression 1
  • Refractory pain 1
  • Neurologic deficit 1
  • Failure of conservative management 3
  • Cosmetic reasons in select cases 3

Natural History and Prognosis

• The natural history of Scheuermann disease remains controversial, with conflicting reports regarding the severity of pain and physical disability 1
• It might be associated with increased risk of back pain in adulthood 2
• Since we cannot predict which kyphotic curves will progress, determining the effectiveness of brace treatment is challenging 1
• Earlier treatment generally leads to better outcomes, highlighting the importance of early diagnosis 2

Clinical Monitoring

• Regular monitoring is essential during growth to prevent evolution and achieve better spinal alignment in adulthood 6
• Patients should be evaluated for progression of the deformity, especially during growth spurts 6
• The earlier the start of treatment, the better the outcome 2