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Scheuermann's Disease: Difference between revisions
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Scheuermann's disease (SD) is a developmental disorder in adolescence that causes hyperkyphosis of the thoracic and thoracolumbar spine. It is characterised by vertebral body wedging, vertebral endplate irregularities, diminished anterior vertebral growth, Schmorl's nodes, narrowing of the intervertebral disc space, and premature disc degeneration. It most commonly occurs in the adolescent growth spurt between the ages of 12 and 15, but can occur as early as late preschool.{{#pmid:2489844|bezalel}} | Scheuermann's disease (SD) is a developmental disorder in adolescence that causes hyperkyphosis of the thoracic and thoracolumbar spine. It is characterised by vertebral body wedging, vertebral endplate irregularities, diminished anterior vertebral growth, Schmorl's nodes, narrowing of the intervertebral disc space, and premature disc degeneration. It most commonly occurs in the adolescent growth spurt between the ages of 12 and 15, but can occur as early as late preschool.{{#pmid:2489844|bezalel}} | ||
==Classification== | |||
There are two curve patterns. <ref name="bezalel"/> | |||
#Thoracic pattern: the most common. Associated with a non-structural hyperlordosis of the lumbar and cervical spine. | |||
#Thoracolumbar pattern: this is rare, and is more likely to progress during adult life. Also known as lumbar type 2 Scheuermann's disease, or Apprentice kyphosis. This is more common in athletic adolescent males or in those that do heavy lifting. There is no significant kyphosis clinically. | |||
==Aetiology== | ==Aetiology== | ||
| Line 18: | Line 23: | ||
Prevalence studies report a range of 0.4 to 8%. These figures may be a lower limit due to the condition being generally underdiagnosed. Most studies indicate a male predominance. <ref name="bezalel"/> | Prevalence studies report a range of 0.4 to 8%. These figures may be a lower limit due to the condition being generally underdiagnosed. Most studies indicate a male predominance. <ref name="bezalel"/> | ||
== | ==Imaging== | ||
The standing lateral radiograph is used to make the diagnosis. The arms are held at a 45° angle below the horizontal line | |||
#Thoracic Cobb angle of at least 45 degrees | |||
#*Measured from the superior endplate of T3 to the inferior endplate of T12. | |||
#*Normal values: The normal range is 25° to 45°. It tends to increase with age in the normal population and is slightly greater in women. Lumbar lordosis normal range is 36° to 56°. The transitional T10-L2 zone is slightly lordotic at 0° to 10°. | |||
#Vertebral wedging of at least one vertebra at a minimum of 5° | |||
Most studies use the 1964 Sorenson criteria which stipulates wedging of a minimum of 5° of three or more adjacent apical vertebrae. The 1987 Drummond criteria only required two or more adjacent vertebrae. The 1987 Sachs criteria only require one vertebra to be wedged along with a thoracic kyphosis of more than 45° (T3-T12).<ref name="bezalel"/> | Most studies use the 1964 Sorenson criteria which stipulates wedging of a minimum of 5° of three or more adjacent apical vertebrae. The 1987 Drummond criteria only required two or more adjacent vertebrae. The 1987 Sachs criteria only require one vertebra to be wedged along with a thoracic kyphosis of more than 45° (T3-T12).<ref name="bezalel"/> | ||
The [[Sagittal Balance of the Spine|sagittal balance of the spine]] can be assessed by looking at the C7 plumb line. This is the C7 vertebral body vertical axis and it should lie vertically within 2cm of the sacral promontory. In patients with SD the spine tends to have a negative balance with the C7 plumb line lying behind the sacral promontory.<ref name="bezalel"/> | |||
==Treatment== | ==Treatment== | ||
Revision as of 09:44, 11 July 2021
This article is a stub.
Scheuermann's disease (SD) is a developmental disorder in adolescence that causes hyperkyphosis of the thoracic and thoracolumbar spine. It is characterised by vertebral body wedging, vertebral endplate irregularities, diminished anterior vertebral growth, Schmorl's nodes, narrowing of the intervertebral disc space, and premature disc degeneration. It most commonly occurs in the adolescent growth spurt between the ages of 12 and 15, but can occur as early as late preschool.[1]
Classification
There are two curve patterns. [1]
- Thoracic pattern: the most common. Associated with a non-structural hyperlordosis of the lumbar and cervical spine.
- Thoracolumbar pattern: this is rare, and is more likely to progress during adult life. Also known as lumbar type 2 Scheuermann's disease, or Apprentice kyphosis. This is more common in athletic adolescent males or in those that do heavy lifting. There is no significant kyphosis clinically.
Aetiology
The aetiology is not completely understood. Theories include:
- Genetic: It seems to have an autosomal dominant inheritance pattern with high penetrance and variable expressivity. A large twin study that looked at self-reported previous diagnoses of SD found that there was a major genetic contribution with odds ratios of 32.92 in monozygotic and 6.25 in dizygotic twins, and heritability of 74%. [2]
- Mechanical factors: Repetitive activities including repetitive loading in the immature spine. It is thought that there may be an altered remodelling response to abnormal biomechanical stress. Individuals with SD tend to be heavier and taller but this may be a consequence of other upstream factors (e.g. hormonal), rather than a cause of SD itself.
- Increased growth hormone levels
- Defective collagen fibril formation and resultant weakened vertebral end plate
- Juvenile osteoporosis: many studies have found lower bone mineral density in SD patients. However it isn't known if this is a consequence of decreased physical activity due to pain, or a primary causative factor of SD.
- Sternum length: There is an association of shorter sternums with SD development. It isn't known if this is a primary cause, but if it is it could be explained by the shorter sternum causing increased forces on the anterior aspect of the thoracic vertebrae.
- Trauma
- Vitamin A deficiency
- Poliomyelitis
- Epiphysitis
Epidemiology
Prevalence studies report a range of 0.4 to 8%. These figures may be a lower limit due to the condition being generally underdiagnosed. Most studies indicate a male predominance. [1]
Imaging
The standing lateral radiograph is used to make the diagnosis. The arms are held at a 45° angle below the horizontal line
- Thoracic Cobb angle of at least 45 degrees
- Measured from the superior endplate of T3 to the inferior endplate of T12.
- Normal values: The normal range is 25° to 45°. It tends to increase with age in the normal population and is slightly greater in women. Lumbar lordosis normal range is 36° to 56°. The transitional T10-L2 zone is slightly lordotic at 0° to 10°.
- Vertebral wedging of at least one vertebra at a minimum of 5°
Most studies use the 1964 Sorenson criteria which stipulates wedging of a minimum of 5° of three or more adjacent apical vertebrae. The 1987 Drummond criteria only required two or more adjacent vertebrae. The 1987 Sachs criteria only require one vertebra to be wedged along with a thoracic kyphosis of more than 45° (T3-T12).[1]
The sagittal balance of the spine can be assessed by looking at the C7 plumb line. This is the C7 vertebral body vertical axis and it should lie vertically within 2cm of the sacral promontory. In patients with SD the spine tends to have a negative balance with the C7 plumb line lying behind the sacral promontory.[1]
Treatment
The rarer lumbar Scheuermann's disease is non-progressive and typically resolves with rest, activity modification, and time. [1]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Russell & Phillips. A preliminary comparison of front and back squat exercises. Research quarterly for exercise and sport 1989. 60:201-8. PMID: 2489844. DOI.
- ↑ Damborg et al.. Prevalence, concordance, and heritability of Scheuermann kyphosis based on a study of twins. The Journal of bone and joint surgery. American volume 2006. 88:2133-6. PMID: 17015588. DOI.
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
