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 film.
- occurs in ~5% (range 0.4-8%) of the general population 2
- slight male predominance
Its exact aetiology is unknown but a proposed mechanism is by aseptic necrosis of the ring vertebral apophyses. Excess axial spine load due to heavy weight lifting may also contribute.
There is a strong hereditary predisposition (perhaps autosomal dominant) with a high degree of penetrance and variable expressivity.
Occurs in the thoracic spine in up to 75% of cases, followed by the thoracolumbar spine combined and occasionally lumbar and rarely cervical spine.
- type I: thoracic spine only
- 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.
To apply the label of classical Scheuermann disease, one needs to meet a number of criteria (Sorensen classification 9):
- thoracic spine kyphosis >40 deg (normal 25-40 deg) or
- thoracolumbar spine kyphosis >30 deg (normal 0 deg)
- at least 3 adjacent vertebrae demonstrating wedging of >5 degrees
Other signs include:
- vertebral end plate irregularity due to extensive disc invagination
- intervertebral disc space narrowing, more 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 Danish orthopaedic and radiologist Holger Werfel Scheuermann, who first described it in 1920 as Osteochondritis deformans juvenilis dorsi 10.
- 1. Summers BN, Singh JP, Manns RA. The radiological reporting of lumbar Scheuermann's disease: an unnecessary source of confusion amongst clinicians and patients. Br J Radiol. 2008;81 (965): 383-5. doi:10.1259/bjr/69495299 - Pubmed citation
- 2. Ali RM, Green DW, Patel TC. Scheuermann's kyphosis. Curr. Opin. Pediatr. 1999;11 (1): 70-5. Curr. Opin. Pediatr. (link) - Pubmed citation
- 3. Lowe TG. Scheuermann disease. J Bone Joint Surg Am. 1990;72 (6): 940-5. J Bone Joint Surg Am (pdf) - Pubmed citation
- 4. Gustavel M, Beals RK. Scheuermann's disease of the lumbar spine in identical twins. AJR Am J Roentgenol. 2002;179 (4): 1078-9. AJR Am J Roentgenol (citation) - Pubmed citation
- 5. Blumenthal SL, Roach J, Herring JA. Lumbar Scheuermann's. A clinical series and classification. Spine. 1987;12 (9): 929-32. - Pubmed citation
- 6. Tribus CB. Scheuermann's kyphosis in adolescents and adults: diagnosis and management. J Am Acad Orthop Surg. 6 (1): 36-43. J Am Acad Orthop Surg (citation) - Pubmed citation
- 7. Tsirikos AI, Jain AK. Scheuermann's kyphosis; current controversies. J Bone Joint Surg Br. 2011;93 (7): 857-64. J Bone Joint Surg Br (full text) - doi:10.1302/0301-620X.93B7.26129 - Pubmed citation
- 8. Summers BN, Singh JP, Manns RA. The radiological reporting of lumbar Scheuermann's disease: an unnecessary source of confusion amongst clinicians and patients. Br J Radiol. 2008;81 (965): 383-5. Br J Radiol (full text) - doi:10.1259/bjr/69495299 - Pubmed citation
- 9. Sørensen KH. Scheuermann's juvenile kyphosis. København: Munksgaard 1964:222-4
- 10. Scheuermann HW. Kyphosis dorsalis juvenilis. Ugeskr Læger 1920;82:385-93.
- 11. Heithoff KB, Gundry CR, Burton CV et-al. Juvenile discogenic disease. Spine. 1994;19 (3): 335-40. Pubmed citation