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Scheuermann’s disease: symptoms, course, therapy

by Josephine Andrews
Published: Last Updated on 352 views

Scheuermann’s disease is a deforming back disease that causes a characteristic curvature of the spine in adolescence. Depending on the severity, those affected may get a hump and suffer from pain and restricted mobility as adults. With early therapy, however, the symptoms of Scheuermann’s disease can usually be controlled well. Here you can read everything you need to know about symptoms, the course of the disease and prognosis.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

M42

quick overview

  • Symptoms: The deformation of the spine leads to a hunchback or hunchback, restricted movement and pain.
  • Course of the disease: With early diagnosis and consistent therapy, the disease can often be well contained, severe courses are rare.
  • Causes: The causes are not exactly known, but hereditary factors and certain risk factors such as weak back muscles probably play a role.
  • Diagnosis: Diagnosis is based on a physical examination and imaging tests, particularly an X-ray.
  • Treatment: The treatment is usually conservative with physiotherapy and wearing a corset, an operation is usually not necessary.
  • Prevention: Regular exercise and an upright posture are suitable for preventing growth disorders. It is advisable to avoid sitting for long periods.

What is Scheuermann’s disease?

Scheuermann’s disease, sometimes also known as Scheuermann’s syndrome or Scheuermann’s disease, is a relatively common growth disorder of the spine. From adolescence it leads to a typical curvature of the spine (hunched back), which usually occurs at chest level (thoracic), more rarely in the lumbar region (lumbar).

Boys are significantly more likely to be affected by Scheuermann’s disease than girls. The disease most commonly begins between the ages of 10 and 13. The expression differs from case to case.

Structure of the spine

In order to understand what happens in Scheuermann’s disease, it is important to know the structure of the spine. Roughly simplified, it can be described as cubes (vertebral bodies) stacked on top of each other with elastic buffers (intervertebral discs) between them.

The stack is by no means straight. When viewed from the side, it has a double “S” shape. Like every structure in the human body, the spine must grow evenly during childhood and adolescence. However, this is not the case with Scheuermann’s disease, so that the vertebral bodies assume an incorrect shape.

What happens with Scheuermann’s disease?

In relation to the cube model, this means that the front edge of the cube pointing towards the chest/belly grows more slowly than the edge pointing back. As a result, the vertebral body takes on the shape of a wedge, with the tip pointing towards the abdominal side. That is why Scheuermann’s disease is also referred to as wedge vertebrae.

If several wedge vertebrae of this kind are placed one on top of the other, this results in a pathological, backwards curvature of the spine. In the thoracic vertebrae area, a slight backwards curvature of the spine (kyphosis) is quite normal, but it is very pronounced in Scheuermann’s disease. In this case, doctors also speak of hyperkyphosis.

Unlike the thoracic spine , the lumbar spine normally has a natural forward curve (lordosis). Scheuermann’s disease causes this forward curvature to weaken and the back to flatten out in the lower area (flat back). However, the lumbar spine is much less commonly affected in Scheuermann’s disease than the thoracic spine.

What are the symptoms of Scheuermann’s disease?

Scheuermann’s disease varies greatly from person to person. Sometimes it does not cause any noticeable discomfort in the early stages and is only an incidental finding. If the disease progresses, those affected suffer from the following symptoms:

  • A pronounced hump or rounded back, with the shoulders usually falling forward and the chest sinking in
  • Movement and functional restrictions
  • back pain
  • Strong mental stress due to the aesthetic aspect

If spinal deformities lead to a severely curved back, Scheuermann’s disease may cause breathing problems. In addition to pain and poor posture, the possible long-term effects of the disease include neurological symptoms such as abnormal sensations in certain parts of the body. These are caused by pressure on the nerve tracts that are responsible for the sensation messages. Late effects in adulthood include herniated discs in the lumbar spine.

How does Scheuermann’s disease progress?

Scheuermann’s disease usually begins with the first pubertal growth spurt and progresses as the child grows. Once this is complete, the deformation of the vertebral bodies also comes to a standstill. However, the existing deformities and damage remain for life and cannot be reversed. The resulting incorrect posture and stress on the spine often leads to increasing complaints and long-term consequences such as pain and herniated discs.

Using certain course parameters such as the Cobb angle, the doctor monitors the progression of Scheuermann’s disease during the growth phase.

Important factors affecting the prognosis are

  • the severity of the deformity of the spine
  • the extent of any accompanying scoliosis , ie a lateral curvature of the spine
  • the body weight

With early and consistent therapy, the prognosis is usually favorable. Severe forms of Scheuermann’s disease are rare.

Causes and risk factors

What ultimately triggers Scheuermann’s disease is not exactly known to this day. However, there seems to be a hereditary component, since the disease tends to run in families. Some of those affected have a general reduced load capacity of the vertebral bodies or congenital anomalies in their marginal ridges. Vitamin deficiency syndromes also sometimes play a role in Scheuermann’s disease.

There are also certain risk factors that are suspected of promoting Scheuermann’s disease:

  • Long, hunched sitting with increased bending stress on the spine
  • Weak abdominal and back muscles
  • competitive sports
  • Rapid growth

investigations and diagnosis

First, the doctor will ask some questions about your medical history, certain risk factors, your job, and sports and leisure activities. In this way, it is possible to narrow down the symptoms and rule out diseases with a similar appearance to Scheuermann’s disease.

In the case of pain, it is important, among other things, when and in which area it started. The nature of the pain (dull, stabbing, constant or movement-dependent) also plays a role. At the same time, the doctor searches for functional restrictions and neurological symptoms.

This is followed by the physical examination, in which the doctor assesses the shape of the spine, mobility and pain intensity. The severity of Scheuermann’s disease can also be determined in this way. In order to confirm the suspected diagnosis, imaging procedures are usually necessary, especially an X-ray examination of the spine.

On the x-ray, the doctor recognizes typical features of Scheuermann’s disease, in particular the wedge vertebrae, but also other changes in the bottom and top plates of the vertebral bodies. The so-called Cobb angle, which can be determined from the X-ray images based on the vertebral body positions, describes the extent of the curvature. This value is very important for follow-up monitoring.

In individual cases, the doctor also arranges for magnetic resonance imaging (MRI). 

treatment

The aim of treating Scheuermann’s disease is to prevent severe deformation of the spine. The earlier a doctor diagnoses the disease, the easier it is to do so. The focus is initially on conservative therapy, which includes different measures. Surgery is rarely done.

physical therapy

With the help of physiotherapy, special exercises can be used to strengthen the muscle groups that counteract a curvature of the spine. In addition, the affected sections of the spine remain mobile in this way. Through the exercises, those affected also specifically stretch those muscle parts that are incorrectly strained and shortened by the incorrect posture.

corset therapy

From a certain degree of curvature, it is advisable to wear a support corset. The main goal is to prevent Scheuermann’s disease from progressing further. Initially, those affected should wear the corset almost continuously, later only at night or by the hour.

The corset is always an individual custom-made product. Due to growth, it is very important to regularly check the fit of the corset and adjust it if necessary. Since affected children and young people are often teased because of their corset, resistance to this therapy is often great. With consistent use, however, good results can be achieved.

Medical therapy

Nothing can be done with medication against the causes of Scheuermann’s disease, but they can against some symptoms. For example, the doctor uses the active ingredients paracetamol and ibuprofen to combat the pain . Muscle-relaxing drugs (muscle relaxants) help against tension caused by persistent poor posture.

Surgical therapy

An operation in the context of Scheuermann’s disease is usually only carried out when the growth phase of the affected person is complete and a certain angle of curvature has been exceeded. Other criteria such as chronic pain, impaired lung function or cosmetic aspects also play a role here.

During the operation, the surgeon removes damaged discs and replaces them with the body’s own bone material. At the same time, he straightens and stabilizes the spine with the help of metal plates and screws. Those affected often have to wear a corset for a few months after an operation.

Prevent

Since Scheuermann’s disease presumably has a hereditary component, the disease can only be prevented to a limited extent. However, there are things parents and young people can do to reduce the risk of spinal curvature.

This includes, above all, ensuring good back muscles and an upright posture at an early stage. Very simple measures are suitable for this, in particular regular exercise. Swimming is particularly good , but there are also many other activities such as ball sports, dance and gymnastics. The most important thing is that the child has fun.

On the other hand, sitting for hours or doing activities that promote bad posture, such as playing games on the cell phone for a long time, are unfavorable. When doing homework, a high-quality desk chair and an ergonomic desk are helpful to enable a good sitting position.

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