Thoracic back injury – Scheuermann’s disease / Kyphosis (by Anca Wessels, Biokineticist)

Scheuermann’s disease is classified as the wedging together of several bones of the spine (vertebrae) in a row which then causes a rounded upper back.

It can otherwise be described as a hunched back or severe kyphosis.

Normal curvature of the upper (thoracic) spine is 20 – 50 degrees. A curvature of more than 50 degrees, where the spine has three contiguous vertebral bodies that have wedging of 5 degrees or more, constitutes Scheuermann’s disease.

This disease is mainly found in teenage boys. It is commonly found throughout their growth spurt years.

The cause of Scheuermann’s disease is unknown, but it is thought to be due to osteochondrosis. This is where the vertebral growth plate stops growing on one side, but continues on the other.

The causes of kyphosis are:

· Degenerative diseases of the spine (such as arthritis or disk degeneration)
· Fractures caused by osteoporosis (osteoporotic compression fractures)
· Injury (trauma)
· Slipping of one vertebra forward on another (spondylolisthesis)
· Certain endocrine diseases
· Connective tissue disorders
· Infection (such as tuberculosis)
· Muscular dystrophy
· Neurofibromatosis
· Polio
· Spina bifida
· Tumors

Treatment:

· Scheuermann's disease is treated with a brace (in severe cases) and by doing specific exercises.
· Occasionally surgery is needed for large (greater than 60 degrees), painful curves.
· Kyphosis is best treated by doing regular specific exercises and stretching.

Adolescents with Scheuermann's disease that need surgery tend to do very well and full recovery is at a high percentage.

The best way to identify this problem is to have thoracic spine x-rays done.

Postural kyphosis can be distinguished from Scheuermann’s by the fact that the deformity goes away when the patient lies down. Typically, patients with true Scheuermann’s need to sleep on more pillows at night to stay comfortable because their deformity remains when they lie down.

Prevention:

·       Early diagnosis and bracing (if necessary) of Scheuermann's disease can reduce the need for surgery, but there is no way to prevent the disease.
·       Treating and preventing osteoporosis can prevent many cases of kyphosis in the elderly.
·       Living a healthy lifestyle and doing regular exercise can prevent kyphosis from occurring.

Scheuermann’s disease (condition of adolescent kyphosis) should not be confused with Juvenile disc disorder (condition of adolescent disc disorder).