An Overview of Scheuermann's Disease

Abnormal Kyphosis in Teens

Teenage girl at the doctor with back pain

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Scheuermann's disease, also called Scheuermann's kyphosis or Scheuermann's juvenile kyphosis, is a structural deformity that occurs usually in the thoracic spine, and sometimes in the lumbar spine, of adolescents typically between the ages of 13 and 16. The hallmark of Scheuermann's disease is a noticeable, abnormal curve in the spine.

A normal thoracic spine has a curvature—or kyphosis—of between 20 to 40 degrees. With Scheuermann's kyphosis, the thoracic curve is usually 45 to 75 degrees. There will also be "wedging" of greater than five degrees of three or more vertebrae that are next to each other (the vertebrae in these cases have a triangular appearance, so they wedge together and reduce the normal space between vertebrae).

Between 1/2 percent and up to 10 percent of the population are thought to have Scheuermann's kyphosis.

Symptoms

Back pain is a common symptom of Scheuermann's disease. This is especially true early on, during the teenage years. Back pain that is associated with Scheuermann's tends to lessen with the approach of adulthood. Pain may be located at the highest part of the kyphotic curve. People with Scheuermann's may also have tight hamstring muscles.

There are two forms of Scheuermann's kyphosis—type I and type II. Type I is the "classic" type 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, 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 is also associated with a greater amount of pain.

The disease is often discovered when parents notice the onset of poor posture or slouching in their child; A teen might complain of fatigue and mid-back pain. Pain typically increases with time and length of the deformity. In some cases, a patient with Scheuermann's kyphosis also has scoliosis, another type of spinal deformity that is not uncommon in teenagers. In scoliosis, the curve of the spine curves from side-to-side. It is estimated that about one-third of people with Scheuermann's disease also have scoliosis.

Rarely, the disorder can cause a decrease in lung and cardiac functions, if the curve of the spine causes the chest to have less room inside the chest cavity. If the deformity is severe, the chest cannot expand fully when breathing. Eventually, the heart can be affected by the poor lung function.

Causes

Scheuermann's disease is congenital, meaning it is present at birth. Many theories have been proposed for the cause of the disease, but the cause is unknown. There seems to be a high genetic predisposition to this disease. Development of the disease tends to correspond to the timing of the growth spurt in adolescence.

Diagnosis

After a thorough physical examination, you will have an X-ray of your spine. If the problem is simply due to postural problems, nothing else abnormal will show up on the X-ray. But if the kyphosis is due to Scheuermann's disease, the X-ray will show three or more adjacent vertebra that are wedged together at least five degrees each.

A diagnosis of Scheuermann's disease is made when the thoracic spinal curve is greater than 45 degrees and three adjacent vertebrae have at least five degrees of wedging.

In the thoracolumbar spine (the transition area between the lumbar and thoracic spine), the kyphosis needs to be only 30 degrees for a diagnosis to be made.

Deformity associated with Scheuermann's disease is most easily seen when looking at a side view of the body, with the person bending forward. From this vantage point, a sharp, angular, abnormal kyphosis, which is caused by asymmetrical growth of adjacent vertebrae, is easily noticed.

Because of this, kyphosis due to Scheuermann's does not correct when the person stands upright.

On the contrary, people with a postural type kyphosis in their thoracic spine (often caused by muscle imbalances between the groups that control shoulder, chest, and upper back movements) generally have symmetrical growth of their vertebrae. In this case, the kyphotic curve does disappear when they stand up straight.

Treatment

For many people with Scheuermann's disease, the deformity remains mild throughout their lives and all that is needed is an X-ray done from time to time to assess any changes.

If you have Scheuermann's kyphosis that is either moderate or severe (55 to 80 degrees) while your bones are still growing, you may need to wear a brace and do specific exercises prescribed by your doctor or physical therapist.

Typically, a brace is worn to try to "guide" the growth of the vertebrae in order to straighten the spine. The brace will only successfully straighten the spine in patients who are still growing. The brace is designed to hold the spine in a straighter, upright posture. This is thought to work by taking pressure off the front half of the vertebra, allowing the growth of the bone in the front to catch up with the growth in the back of the vertebra.

Typically, the brace is worn from 16 to 24 hours a day for a year, then only at night for two years. Physical therapy might also be recommended to strengthen the back and improve posture, though it is not clear if that is beneficial.

Surgery is sometimes recommended for those in which the kyphosis exceeds 75 degrees when measured on X-rays. Surgery typically consists of a fusion of the abnormal vertebrae. Surgery is usually done through a posterior-only approach. 

A Word From Verywell

Scheuermann's kyphosis may cause enough of a curvature in the spine to cause pain and perhaps self-consciousness in those who have it, but in general, it is not a dangerous condition and should not interfere with a person's daily activities.

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