Scheuermann's Disease

This type of kyphosis is most commonly seen in boys and may become noticeable during adolescence. The kyphosis is related to abnormal development of the vertebrae in the spine (usually the upper back, thoracic spine) which leads to wedge-shaped, instead of rectangular-shaped vertebral bodies. Additionally, there can be abnormal development of the intervertebral discs leading to herniations into the adjacent vertebrae (uncommonly into the spinal canal). When this occurs, the vertebral endplate becomes irregular and this is often referred to as a Schmorl's node. Although the wedging of vertebrae in Scheuermann's is most commonly in the thoracic spine, it may occur in the junction between the thoracic and lumbar spines, or purely in the lumbar spine.

The treatment of Scheuermann's disease depends upon the degree of kyphosis, the age of the patient and the levels of the spine which are affected. Early diagnosis is key in optimally treating this type of kyphosis. In a skeletally immature patients (still growing) treatment for significant deformity is directed at bracing. A custom brace is made and worn by the patient 23 hours a day during remaining growth (until skeletal maturity) in order to assist remodeling and corrected growth of the spine. Once an adolescent has stopped growing, or in older adults, bracing is no longer an effective option in correcting abnormal curvature. Treatment at that point is directed toward symptoms such as pain, fatigue, weakness and possible neurologic problems due to spinal stenosis or disc herniations. In mild cases physical therapy, strengthening exercises, pain modalities and medication/bracing may help.

A gradual progression of kyphosis may be noted in Scheuermann's despite bracing in an adolescent. In an adult the symptoms of a significant kyphosis may also become increasing disabling. When bracing, therapy and other non-operative treatments fail, surgery may be an option to consider. Each case must be approached in a very individual manner and a complete and thorough evaluation by an experienced specialist is important prior to planning any treatment program. If surgery is considered, the goals must include correction of deformity, and obtaining a balanced and stable spine. Numerous techniques have been developed to treat severe kyphosis, and new approaches such as endoscopic surgery appear promising.

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