What Is Scheuermann's Disease?

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 congenital skeletal deformity characterized by an exaggerated curve (kyphosis) of the thoracic (middle) spine, Symptoms of Scheuermann's disease include pain and poor posture that arise during adolescence, at which point the condition can be diagnosed with an X-ray. Scheuermann's disease can be treated with stretching, lifestyle changes, non-steroidal anti-inflammatory drugs (NSAIDs) for pain and discomfort, and in some situations, a back brace. Rarely, heart and lung function may be impaired. Between .5% and up to 10% of the population is thought to have Scheuermann's kyphosis.

Types of Scheuermann's Disease

The upper and middle areas of the spine are called the thoracic spine, consisting of the 12 vertebrae below the seven that make up the cervical spine. The thoracic spine connects to the rib cage, which protects the heart, lungs, and other organs. The five vertebrae below the thoracic spine make up the lumbar spine. Each area normally has a curvature. The outward curve in the thoracic spine is called a kyphosis. There are two types of the condition:

Type I: "Classic" Scheuermann's disease is the most common type, affecting the area between the seventh and ninth thoracic vertebrae. 

Type II: Type II, or "atypical" Scheuermann's disease, is less common, affecting the lower thoracic spine (also known as the thoracolumbular spine) and sometimes the lumbar spine. The pronounced area, or apex, of the curve is between the 10th and 12th vertebrae.

Symptoms

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. In some cases, a person 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.

Back pain is the most common symptom of Scheuermann's disease, especially early on, with the pain being more severe in type II. Pain may be located at the highest part of the kyphotic curve. People with Scheuermann's also may have tight hamstring muscles.

When the kyphosis is severe, the disorder can cause a decrease in lung and cardiac functions, if the curve of the spine causes a decrease in the space inside the chest cavity, limiting the ability of the chest to expand fully when breathing. Eventually, the heart can be affected by poor lung function.

Boys are twice as likely to be diagnosed with Scheuermann's kyphosis as girls.

Causes

Many theories have been proposed for the cause of the disease, but the exact cause is unknown. There seems to be a high genetic predisposition, and development of the disease tends to correspond to the timing of the growth spurt in adolescence. Boys are twice as likely to develop Scheuermann's kyphosis than girls.

Normally, the vertebrae are rectangular, with flexible cartilage in between them. In Scheuermann's, the front part of the affected vertebrae grow more slowly than the back edge.  This causes the wedge-shaped vertebra and the excessive rounding of the back that are the hallmarks of the condition.

Some research has indicated that the anterior longitudinal ligament, a ligament that runs along the front of the spine, may be unusually thick and tight in people with Scheuermann's disease, and that the ligament may affect the abnormal growth of the vertebra. Muscle abnormalities in the spinal region may also be involved in causing the abnormality.

Diagnosis

Most kids are diagnosed with type I between 12 and 15 years old, and type II between 15 and 18.

To make a diagnosis of Scheuermann's, the doctor will perform a physical exam and ask the child to stand, bend from the waist, and lie down. 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, the abnormal kyphosis is very noticeable.

Kyphosis due to Scheuermann's does not correct when the person stands upright. People with a postural type of 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.

The next step is an X-ray of the 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 normal thoracic spine has a kyphosis of between 20 to 40 degrees. 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 type II, the kyphosis needs to be only 30 degrees for a diagnosis to be made.

In some cases, the doctor will recommend an MRI (magnetic resonance imagining) to rule out an infection or a tumor that could be causing the pain; pulmonary function tests may be done if breathing seems to be affected.

Treatment

The majority of teens with Scheuermann's kyphosis will find relief with some combination of stretching exercises, lifestyle modifications, physical therapy, and non-steroidal anti-inflammatory pain relievers (NSAIDs).

In the case of Scheuermann's kyphosis that is either moderate or severe (55 to 80 degrees) while the bones are still growing, it may be necessary to wear a brace and do specific exercises prescribed by a doctor or physical therapist.

A brace is often 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, and is usually done with the patient lying on their stomach. 

A Word From Verywell

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

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