Scheuermann disease

Last revised by Dr Daniel J Bell on 12 Jan 2022

Scheuermann disease, also known as juvenile kyphosisjuvenile 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.

  • 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

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.

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
  • 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

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

Management is largely dependent on the degree of kyphosis:

  • <50°: conservative, stretching, postural changes
  • 50-75°: brace
  • >75°: surgery

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!

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Cases and figures

  • Case 1: early stages before progressing to kyphosis
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6
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  • Case 7
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