Diagnosing Scheuermanns Disease

Kyphosis in Teens

Consultation, child in pain

BSIP/Getty Images

Scheuermann's kyphosis, also known as Scheuermann's disease is one type of osteochondrosis. Osteochondrosis refers to a number of skeletal problems that are due to abnormal growth, injury or overuse in the bones of adolescents.

According to experts, Scheuermann's kyphosis is a disease that occurs during the growth spurt, affecting the cartilage located at the endplate of spinal bones. In their article entitled "Scheuermann's disease: an update", published in the May 2014 edition of Joint Bone Spine, Palazzo, et. al. say that Scheuermann's is likely due to repetitive strain in the endplate cartilage; this strained cartilage, they say, is further is further weakened by genetic predisposition.

While the term "Scheuermann's kyphosis" is generally associated with abnormality occurring in the thoracic spine, this disease is known to affect the lumbar (low back) spine, as well. Palazzo, et al suggest that Scheuermann's in the lumbar spine may be as frequent as the thoracic type, and may even be more painful to the patient. Disc problems are also frequent in patients with Scheuermann's disease.

Scheuermann's Kyphosis Definitions

The meaning of the term "Scheuermann's disease" can vary according to who you ask. Palazzo and associates assert that it can fit a more classical definition. The classical definition of this type of kyphosis was put forth by Scheuermann himself, who was a Danish orthopedic surgeon practicing in the early part of the 20th century.

Scheuermann's classic definition of the disease was: A thoracic kyphosis of greater than 45 degrees plus more than 5 degrees of wedging at the front of at least 3 consecutive vertebra that are located at the apex (tip) of the kyphosis and irregularities at the vertebral endplate. Today, this definition is referred to as the Sorensen criteria.

Alternatively, defining Scheuermann's kyphosis may be simply a matter of finding abnormalities on an x-ray or other film in patients with no symptoms.

So what does the doctor look for in an x-ray of Scheuermann's kyphosis? Generally, she will locate any changes or abnormalities (called lesions) at or near the vertebral endplate, including the wedging discussed above as well as irregularity of the endplate itself. She may also notice any Schmorl's nodes, i.e. lesions in which the soft intervertebral disc pushes either down or up into the vertebral bone next to it.

Type I and Type II

There are two forms of Scheuermann's kyphosis—type I and type II. Type I is the "classic" variety described above, and occurs in the thoracic spine. The apex of the curve is located between the 7th and 9th thoracic vertebrae. Type 1 Scheuermann's kyphosis is also associated with an exaggerated lumbar curve (lordosis).

In Type II Scheuermann's kyphosis, the apex of the curve is lower down, and the upper back kyphosis may be reduced. Teens affected by Type II Scheuermann's tend to be a bit older—generally between 15 to 18 years. Type II Scheuermann's kyphosis is also associated with a greater amount of pain.

Early Diagnosis May Result in a More Satisfactory Treatment Outcome

As with most spinal conditions or injuries, the earlier you get treatment, the better your outcomes are likely to be. And to do that, you need to get an early diagnosis. Generally, the first treatment that is tried for Scheuermann's kyphosis is non-surgical, consisting of bracing and physical therapy. If the kyphosis is severe and you've tried physical therapy and bracing to no avail, your doctor may suggest surgery, but this avenue of treatment is not often taken.

Was this page helpful?

Article Sources

  • Alfred, A, Jr., MD; Suken A. Shah, MD; O'Brien, K., MD. et. al. Osteochondrosis: Common Causes of Pain in Growing Bones. DuPont Hospital for Children, Wilmington, Delaware. Am Fam Physician. 2011 Feb 1;83(3):285-291.

  • Hitesh Gopalan U, MS, Senthilnathan MS MD. Scheuermann Disease. Orthopaedic Principles-A Review. April 2010.

  • Palazzo C1, Sailhan F2, Revel M3. Scheuermann's disease: an update. Joint Bone Spine. 2014 May;81(3):209-14. doi: 10.1016/j.jbspin.2013.11.012. Epub 2014 Jan 24.