Scheuermann disease, also known as juvenile kyphosis, juvenile discogenic disease 11, or vertebral epiphysitis, is a common condition which results in kyphosis of the thoracic or thoracolumbar spine. The diagnosis is usually made on plain radiograph.
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Epidemiology
occurs in ~5% (range 0.4-8%) of the general population 2
typical age of presentation is between 12 and 17 years 13
slight male predominance
Pathology
Its exact etiology is unknown but a proposed mechanism is by osteonecrosis of the vertebral apophyseal 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 4,5 for a variant affecting the lumbar region
Associations
Radiographic features
To apply the label of classical Scheuermann disease, the Sorensen criteria need to be met 9:
thoracic spine kyphosis >40° (normal 25-40°) or
thoracolumbar spine kyphosis >30° (normal ~0°)
and
at least 3 adjacent vertebrae demonstrating wedging of >5°
Other signs include:
vertebral endplate irregularity due to extensive disc invagination
intervertebral disc space narrowing, more pronounced anteriorly
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 10,12.
A Danish orthopedic surgeon, Kaj Harry Sørensen, developed his eponymous criteria, based on the painstaking measurement of the wedging of 4,665 vertebrae 14!