scheuermann disease

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sign in Scheuermann"s disease
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with back pain. Lateral radiograph of the lumbar spine shows defects in anterosuperior and anteroinferior aspects of the L1-L4 vertebral bodies due to anterior disk herniation along with mild Schmorl nodes deformities and mild disc space narrowing at these levels.The diagnosis was Scheuermann disease of the lumbar spine.
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Scheuermann disease, also known as juvenile kyphosis, juvenile discogenic disease , or vertebral epiphysitis, is a common condition which results in kyphosis of the thoracic or thoracolumbar spine. The diagnosis is usually made on plain film.

Epidemiology

  • occurs in ~5% (range 0.4-8%) of the general population
  • typical age of presentation is between 12 and 17 years  
  • slight male predominance

Pathology

Its exact etiology is unknown but a proposed mechanism is by aseptic necrosis of the vertebral apophysial rings. Excessive axial spine load due to heavy weightlifting may also contribute.

There is a strong hereditary predisposition (perhaps autosomal dominant) with a high degree of penetrance and variable expressivity.

Location

Occurs in the thoracic spine in up to 75% of cases, followed by the thoracolumbar spine combined and occasionally lumbar and rarely cervical spine.

Classification
  • type I: thoracic spine only
  • type II
    • affecting the lower thoracic spine and lumbar spine
    • some authors have proposed the term lumbar Scheuermann disease for a variant affecting the lumbar region

Radiographic features

To apply the label of classical Scheuermann disease, the Sorensen criteria need to be met :

  • thoracic spine kyphosis >40° (normal 25-40°) or
  • thoracolumbar spine kyphosis >30° (normal ~zero degrees)

and

  • at least 3 adjacent vertebrae demonstrating wedging of >5°

Other signs include:

  • vertebral endplate irregularity due to extensive disk invagination
  • intervertebral disk space narrowing, more pronounced anteriorly

The condition is associated with

Treatment and prognosis

Management is largely dependent on the degree of kyphosis:

  • <50°: conservative, stretching, postural changes
  • 50-75°: brace
  • >75°: surgery

History and etymology

It is named after the Danish orthopedic surgeon and radiologist Holger Werfel Scheuermann (1877-1960) who first described it in 1920 as osteochondritis deformans juvenilis dorsi .

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Morbus Scheuermann:
Spondylolisthesis
 
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