Brief overview
- Symptoms: The deformation of the spine leads to a hump or hunchback, restricted mobility 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, probably hereditary factors and certain risk factors such as weak back muscles play a role.
- Diagnosis: Diagnosis is made with the help of a physical examination and imaging techniques, especially X-rays.
- Treatment: Treatment is usually conservative through physiotherapy and wearing a corset; surgery is usually not necessary.
- Prevention: To prevent the growth disorder, regular exercise and an upright posture are suitable. It is advisable to avoid sitting for long periods of time.
What is Scheuermann’s disease?
Scheuermann’s disease, also known as Scheuermann’s syndrome or Scheuermann’s disease, is a relatively common growth disorder of the spine. From adolescence onwards, it leads to a typical curvature of the spine (hunchback), which usually occurs at chest level (thoracic), more rarely in the lumbar region (lumbar).
Structure of the spine
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 stacked cubes (vertebral bodies) with elastic buffers (intervertebral discs) between them.
The stack is by no means straight. Viewed from the side, it has a double “S” shape. Like any structure of the human body, the spine must grow evenly during childhood and adolescence. In Scheuermann’s disease, however, this is not the case, so the vertebral bodies take on an incorrect shape.
What happens in Scheuermann’s disease?
In terms of the cube model, this means that the front edge of the cube pointing towards the chest/belly grows more slowly than the edge pointing towards the back. As a result, the vertebral body takes on the shape of a wedge with the tip pointing toward the abdominal side. This is why Scheuermann’s disease is also referred to as wedge vertebrae.
If several such wedge vertebrae lie on top of each other, this results in a pathological, backward curvature of the spine. In the thoracic vertebrae, a slight, backward curvature of the spine (kyphosis) is quite normal, but in Scheuermann’s disease it is very pronounced. In this case, doctors also speak of hyperkyphosis.
What are the symptoms of Scheuermann’s disease?
Scheuermann’s disease varies greatly from individual to individual. Sometimes it causes no noticeable symptoms in the early stages and is only an incidental finding. If the disease progresses, affected individuals suffer from the following symptoms:
- A pronounced hump or hunchback, with the shoulders usually dropping forward and the chest sinking in.
- Restrictions in movement and function
- @ Back pain
- @ Strong psychological stress due to the aesthetic aspect
If deformities of the spine lead to a strongly curved back, Scheuermann’s disease may cause breathing problems. In addition to pain and postural damage, the possible late effects of the disease include neurological symptoms such as insensitivity in certain parts of the body. These are caused by pressure on the nerve pathways responsible for sensory messages. Late consequences in adulthood include herniated discs in the lumbar spine.
How does Scheuermann’s disease progress?
Using certain progression parameters, such as the Cobb angle, the doctor checks how much Scheuermann’s disease is progressing during the growth phase.
Important factors that influence the prognosis are
- the severity of the deformity of the spine
- the extent of any accompanying scoliosis, i.e. 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
It is not known exactly what causes Scheuermann’s disease. However, there seems to be a hereditary component, since the disease occurs in families. For example, some affected persons have a general reduced load-bearing capacity of the vertebral bodies or congenital anomalies at their marginal ridges. Vitamin deficiency syndromes also sometimes play a role in Scheuermann’s disease.
Furthermore, there are certain risk factors that are suspected to favor Scheuermann’s disease:
- Sitting for long periods of time in a hunched position with increased bending stress on the spine
- Weak abdominal and back muscles
- Competitive sports
- Rapid growth
Examinations and diagnosis
In the case of pain, it is important, among other things, when and in which area it started. The character of the pain (dull, stabbing, constant or movement-dependent) also plays a role. At the same time, the physician searches for functional limitations and neurological symptoms.
This is followed by a physical examination, during which the doctor assesses the shape of the spine, mobility and pain intensity. This also helps to determine the severity of Scheuermann’s disease. To confirm the suspected diagnosis, imaging procedures are usually necessary, especially an X-ray examination of the spine.
On the X-ray, the physician recognizes typical features of Scheuermann’s disease, especially the wedge vertebrae, but also other changes in the base 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 monitoring the progress of the disease.
In individual cases, the doctor will also arrange for a magnetic resonance imaging (MRI).
Treatment
Physical therapy
With the help of physical therapy, special exercises can be used to strengthen the muscle groups that counteract curvature of the spine. In addition, the affected spinal segments remain mobile in this way. The exercises also allow those affected to stretch the muscles that are incorrectly loaded and shortened as a result of the poor posture.
Corset therapy
From a certain degree of curvature, it is recommended to wear a support corset. The main goal is to prevent Scheuermann’s disease from progressing further. Initially, affected persons should wear the corset almost continuously, later only at night or by the hour.
The corset is always an individual made to measure. Due to growth, it is very important to check the fit of the corset regularly and adjust it if necessary. Since affected children and adolescents are often subjected to teasing because of their corset, resistance to this therapy is often high. However, with consistent use, good results can be achieved.
Drug therapy
Surgical therapy
Surgery for Scheuermann’s disease is usually only performed when the growth phase of the affected person is completely finished and a certain angle of curvature has been exceeded. Other criteria such as chronic pain, a restriction of lung function or cosmetic aspects also play a role here.
During surgery, the surgeon removes damaged intervertebral discs and replaces them with the patient’s own bone material. At the same time, he straightens and stabilizes the spine with the help of metal plates and screws. Patients often have to wear a brace for several months after the operation.
Prevention
Since Scheuermann’s disease is thought to have a hereditary component, it can only be prevented to a limited extent. However, parents and young people have the opportunity to do something to reduce the risk of spinal curvature.
This includes, above all, ensuring good back muscles and an upright posture at an early age. Very simple measures are suitable for this, especially regular exercise. Swimming is particularly good, but so are many other activities such as ball sports, dance and gymnastics. The most important thing is that the child enjoys it.