Scheuermann’s disease (juvenile kyphosis)
The normal spine is somewhat concave in some places (called lordosis) and somewhat curved in other places. Scheuermann’s disease is a back condition in which the back shows an abnormal curvature, called a kyphosis, and the vertebrae deviate. The curved back (also known colloquially as a hunchback) and the extremely hollow back often associated with kyphosis cause pain. Scheuermann’s disease can be treated with physiotherapy, a brace (corset) or surgery.
- The human spine
- What is Scheuermann’s disease?
- Scheuermann’s disease symptoms
- Treatment of Scheuermann’s disease
The human spine
The human back consists of twenty-four vertebrae, which can be divided into three types. The lower back consists of five lumbar vertebrae, the middle part of the back consists of twelve thoracic vertebrae and the upper part of the back and the neck consist of seven cervical vertebrae. Together these vertebrae form the backbone. The human spine is not straight, but is slightly curved in certain places. The lower back and the area on and around the neck is slightly curved towards the body, this is called lordosis . The upper back is a bit more curved. The upper back is therefore slightly curved from birth and this curve becomes increasingly stronger as one gets older. Normally, the lower and upper thoracic vertebrae form an angle of 20 to 45 degrees with each other. However, when this angle is greater than 45 degrees, it is called a kyphosis . Many older people suffer from this phenomenon, which is popularly called a hunchback . However, some people have this hunchback from a very young age. This can have various causes, but the most common causes of so-called juvenile kyphosis are poor posture and Scheuermann’s disease.
What is Scheuermann’s disease?
Scheuermann’s disease is a disease of the vertebrae at the level of the ribs, the thoracic vertebrae. In people with Scheuermann’s disease, there is an abnormal curvature of the upper back , a kyphosis, and an abnormal shape of the thoracic vertebrae. The curvature develops very gradually and usually only becomes clearly visible during puberty. Once the growth spurt has passed, the kyphosis stabilizes and generally does not become much stronger. A lower back kyphosis also occurs, but is much rarer.
The disease is named after Mr. Scheuermann. In 1920 he discovered a very painful kyphosis in a sixteen-year-old farm worker. He called the condition ” kyphosis dorsalis juvenilis “, although the name was soon changed to “Scheuermann’s disease” and ” juvenile kyphosis “.
How common is Scheuermann’s disease?
How often Scheuermann’s disease occurs is also called the prevalence of Scheuermann’s disease . Scheuermann’s disease occurs in approximately 0.4 to 10 percent of adolescents aged 13 to 17 years. Scheuermann’s disease is more common in men.
Cause of Scheuermann’s disease
The precise cause of Scheuermann’s disease is not known, although it is known that the disease has a significant genetic component. Sometimes it is seen that there is more than average amount of growth hormone present in the body. Inadequate closure of the various bones of the vertebrae and a reduced amount of collagen are also found. A recent study shows that the breastbone (sternum) of children with Scheuermann’s disease is smaller. This may cause more pressure to be placed on certain parts of the vertebrae, preventing them from growing equally.
Scheuermann’s disease symptoms
A large number of people with Scheuermann’s disease mention pain as their main complaint, which is mainly located in the middle part of the back or in the lower back. The abnormal curvature of the upper back puts a lot of pressure on the lower back, which can also cause pain here. In addition to kyphosis, many people suffer from moderate scoliosis , a sideways curvature of the spine. It is also noticeable that their neck and head are further forward than is normally the case. Weak abdominal muscles also occur regularly.
Diagnosing Scheuermann’s disease
Research into Scheuermann’s disease can be difficult because the disease has many similarities with other back conditions. For example, Scheuermann’s disease is often confused with kyphosis caused by incorrect posture. To investigate whether the kyphosis is caused by Scheuermann’s disease, a physical examination is performed in which the back is examined in various poses. One of these is the Adams forward-bend test. This involves bending forward and examining what the spine looks like. People with Scheuermann’s disease have a noticeably stiff upper back and an abnormally hollow lower back . In addition, it is noticeable that a fairly sharp angle is made with the lower and upper back, the thoracic vertebrae do not bend sufficiently, as it were, and are not flexible.
In addition to a physical examination in which the spine is viewed from the outside, a bone scan is also made. The spine is viewed from the back and the side, measuring the number of degrees that the angle between the vertebrae covers. This is called the Cobb method . It is striking that the fifth and twelfth thoracic vertebrae have an angle of more than 45 degrees, and that the lordosis in the lower back is greater than normal. In addition, it is often seen that the vertebrae touch each other at the front.
Treatment of Scheuermann’s disease
Scheuermann’s disease can be treated roughly in two ways: surgically and non-operatively. Non-operative treatments consist of physiotherapy and wearing a brace.
Physiotherapy
Many people with Scheuermann’s disease receive physiotherapy to correct their posture to a healthier posture . Exercises include stretching the shoulders back and the hamstrings. Exercises are also done to strengthen the muscles in the torso. This treatment is mainly used when the kyphosis is 55 degrees or less. Physiotherapy ensures that people become more aware of the body and that the pain in the lower back decreases somewhat.
Brace
corset ) is often used , an aid made of a sturdy material that supports your joints and provides counter pressure during wear. The spine is, as it were, gently pushed into the desired position. In principle, the brace is worn until one has grown. Most braces only reduce kyphosis in the upper back. However, the Milwaukee brace corrects both the abnormal curvature of the lower back and the upper back. The disadvantage of the Milwaukee brace is that it is very clumsy and has little aesthetic value due to the large ring that is worn around the neck. When patients wear the brace faithfully, between eighteen and twenty-three hours a day, and gradually reduce its use after about a year and a half, the results are very good. The kyphosis can then be corrected by up to approximately 50%. However, many patients experience some relapse of symptoms after treatment has been completed. Treatment with a brace has a better prognosis if the patient continues to grow for at least one year, the disease is detected and recognized early and the spine is relatively flexible.
Scheuermann’s disease surgery
Typically, surgery is only considered when the disease is very serious and the complaints are very severe, with an angle of more than 70 degrees often used as the minimum strength of the kyphosis. Others even maintain a minimum of 80 degrees. An operation is quite drastic. Nevertheless, in some cases surgery is the only option, because people with severe kyphosis usually do not respond well to a brace. The most common operation is to surgically widen the space between the vertebrae using screws. This operation is especially suitable for people who have not yet grown. When there is very severe kyphosis, great caution is required. Due to the kyphosis, the nerves are placed in a very specific position, which means that they are often shorter than normal. During surgery, the spine is suddenly straightened, creating more space for the nerves. This can result in neurological complaints. In very severe kyphoses, the space between the vertebrae at the front of the body is therefore not only widened, but at the same time the space between the vertebrae at the back of the back is narrowed somewhat.