Scheuermann disease

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Kyphosis and back pain.

Patient Data

Age: 15 years
Gender: Female

Dorsolumbar spine

x-ray

L5-S1 mild anterior spondylolisthesis.

Increased lumbar lordosis and thoracic kyphosis at the standing lateral radiographic view.

Whole spine

mri

Kyphotic deformity of the dorsolumbar spine is noted.

L5-S1 grade I spondylolisthesis is noted.

LV3-4 minimal retrolithesis is noted.

LV4-5 mild diffuse disc bulge, indenting the ventral thecal aspect with no foraminal compromise.

No significant cervical spine abnormalities noted.

Cobb's angle

Annotated image

The angle of thoracic kyphosis is 59 degree (normal thoracic kyphosis Cobb's angel 20° to 50°) 1

There is also at least 3 adjacent thoracic vertebrae demonstrating anterior wedging of >5°

The angle of lumbar lordosis is 59 degree (normal lumbar lordosis Cobb's angel 15° to 47°) 2

Case Discussion

Thoracic kyphosis, lumbar lordosis, lower lumbar instability, and multiple thoracic anterior intervertebral discs osteochondrosis are all features, in such age group, that suggest Scheuermann's disease. It is considered type II as it affects both the thoracic and lumbar spines. There is also associated spondylolisthesis at the lower lumbar spine level.

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