This image depicts typical Scheuermann's Disease in an adolescent male (Figures A). Male subject bends over in "Adams test" for the purposes of finding Scheuermann's Kyphosis. Figure B is the subjects spin in x-rays and MRI, showing the classic wedging shaped vertebra.
What is known for sure is that Scheuermann's Disease often begins in a juvenile spine during development. It is a disease of the growth cartilage endplate (or the smooth surface of our vertebra where the squishy disk is located). There are many hypotheses for how the disease starts its course, some range from genetic disposition, repetitive strain or activity which strain the growing cartilage and create lesions on the endplates and often crush the vertebra into a wedge shape, with some holes that are eaten into the vertebra (Schmorl's nodes or intraossous disk herniation) allowing the squishy disk to herniate into the vertebra.
Scheuermann's Disease was first diagnosed by Sorensen Scheuermann in 1921 as a painful, fixed, dorsal kyphosis (or curvature of the thoracic spine) consisting of wedged vertebrae, with irregularities in the vertebral endplates, occurring in adolescents.
It is thought that Scheuermann's disease effects from 0.4-0.8% of the population, and typically presents its self in early adolescents continuing through teenager-hood.
Scheuermann's Disease, or the "invisible" disease, is a spinal deformity that affects the young as well as those in middle age. Contrary to what many physicians would have you think, IS NOT A BENIGN CONDITION, but rather, IT CAN BE A TERRIBLY PAINFUL LIFELONG SPINAL DISEASE.
The Scheuermann's Disease Fund, a fund of the Pittsburgh Foundation - www.sdfund1.org
What is Scheuermann's Disease?
According to the Federal Register of Legislations Statement of Principles concerning Scheuermann's Disease No. 75 of 2016:
Meaning of Scheuermann's disease:
(2) For the purposes of this Statement of Principles, Scheuermann's disease (also known as juvenile osteochondrosis of the spine) means:
(a) a disease of children and adolescents involving necrosis and regeneration in the growth centres of the thoracic or thoracolumbar vertebrae. It is characterised by a rigid hyperkyphosis due to anterior wedging of at least 5° in one or more consecutive vertebrae. This condition may be accompanied by back pain and, in severe cases, respiratory or neurological complications; and
(b) excludes postural kyphosis.
-Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986. https://www.legislation.gov.au/Details/F2016L01344, Australian Governement.
What is Scheuermann’s disease?
Scheuermann’s disease is a condition characterised by abnormal wedge shaped development of the vertebrae of the upper back with subsequent postural abnormality and excessive curvature (i.e. a ‘hunch back’ or ’roundback’) of the thoracic spine (upper back).
The spine comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the discs centrally (figure 1).
Figure 1 – Relevant Anatomy for Scheuermann’s Disease
Scheuermann’s disease is an osteochondrosis of the spine. This means it affects bony growth of the vertebrae (of the upper back) and results in abnormal development of the bones of the spine at their growth plates. In patients with this condition, one side of the vertebrae (the front) grows more slowly than the back of the vertebrae resulting in a prominent wedge shape of the affected bone with the narrow part of the wedge in front. These changes occur during adolescence at a time of rapid growth and result in an increase in the forward bend of your upper back (i.e. an increased thoracic kyphosis). Whilst Scheuermann’s disease primarily affects the vertebrae of the upper back (thoracic spine), it can sometimes also affect the vertebrae of the lower back (lumbar spine). In addition to wedging of the vertebra, abnormal changes also typically occur at the junction between the vertebra and the disc (i.e. the vertebral end plate). These changes (often seen on X-Ray) are known as Schmorl’s nodes and are characterised by protrusion of some of the disc material into the vertebra. Scheuermann’s disease is a self-limiting condition that affects boys more often than girls, with most patients being asymptomatic and unaware that they have the condition. The prevalence of the condition is approximately 4 – 8% of the general population.
Cause of Scheuermann’s disease:
Whilst the cause of Scheuermann’s disease is not known, the condition does tend to have slightly increased incidence in some families. Some researchers speculate that the condition may be due to pre-existing weakness in vertebral end plates or due to excessive forces being placed on these areas (such as repetitive, prolonged or forceful lifting or bending forwards activities). Other factors which may potentially contribute to the development of the condition include biomechanical factors such as a shortened sternum, increased height (i.e. patients with Scheuermann’s disease tend to be taller than their peers), endocrine disorders and juvenile osteoporosis