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Friday, August 29, 2014

What is Scheuermann's Disease?

This disease was first observed by the Danish physician, Holger Scheuermann. He was an Orthopaedic Surgeon and Radiologist in the early 1900’s. The disease is a childhood disorder of the development of the mid-back (thoracic spine). The vertebrae grow unevenly and become "wedge shaped" rather than square. The reason is that the front of the vertebral body grows slower than the back. This results in the characteristic "wedge" or "pie" shaped vertebral bodies. The wedge shaped vertebrae cause a forward curvature of the mid-back) thoracic spine, called a “kyphosis”.
The most affected vertebrae are T7 and T10. Males are more commonly affected than females.

At what age does Scheuermann’s Disease start?

This disease often becomes apparent in the early teens. It can progress until the bones of the spine are fully grown. During that time, the disease can progress and a hunched mid-back appears. The patient cannot straighten the spine completely. This disease stops to progress once our bones have stopped growing.

What are the symptoms of Scheuermann’s Disease?

Here are some common symptoms of Scheuermann’s disease:
  1. Pain over the mid or low back
  2. Pain over the spine worse with weight bearing
  3. Pain over the spine with prolonged standing or sitting
  4. Forward curvature of the mid-back

How is Scheuermann’s Disease diagnosed?

  1. The diagnosis of Scheuermann’s disease is primarily made with X-Rays: The normal spinal curvature in the mid-back is 20-50 degrees forward. A curvature of more than 50 degrees with 5 wedged vertebrae in a row is diagnosed as Scheuermann’s disease.
Lateral Color X-Ray of Scheuermann's Disease Thoracic Spine
Color X-Ray showing a normal mid-back curvature on the left and abnormal Scheuermann's curvature on right
 
      2. A CT Scan can show more details of Scheuermann's Ds, but is typically not needed.


Color Sagittal Thoracic CT Scan Scheuermann's Disease
Color CT Scan showing Scheuermann's Disease


      3. MRI scans can also show Scheuermann’s disease, but may not be  necessary.

How is Scheuermann’s Disease treated?

Here are some of the common treatments of Scheuermann’s Disease:
  1. Non-Surgical
A. Medications
  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  2. Muscle Relaxants
  3. Pain Killers
B. Bracing

During the teenage years a specific brace (Milwaukee Brace) can be used to treat the curvature in the spine.

C. Exercises
Strengthening and hamstring exercises can be helpful.

D. Physical Therapy (PT)
PT can offer spine exercises, manual therapy, electrical muscle stimulation, aquatics, amongst others to help treat the symptoms of this disease.

E. Massage Therapy
Massage therapy can help with the muscle pain from the abnormal spine curvature.

F. Injections
Some spine injections can help with the symptoms from this disease:
1. Trigger Point Injections
2. Muscle Blocks
3. Thoracic Interlaminar Epidural Steroid Injections

G. Chiropractic Care
Chiropractic adjustments may help with some of the symptoms of patients with Scheuermann’s Disease  


2. Surgical

Surgery can be used to treat severe cases of Scheuermann’s disease. most commonly in the form of a Thoracic Osteotomy and Fusion. This surgery attempts to make the Vertebrae square shaped by removing bone from the back of the Vertebra. Following that, the Spine is fused to keep in the new, straighter form.



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