Scheuermann disease

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.

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

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

The condition is associated with

• Schmorl nodes
• limbus vertebrae
• scoliosis (~25%)
• spondylolisthesis

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!