Scheuermann's Disease, Juvenile Kyphosis: Causes and Symptoms

Scheuermann's disease, also know as Scheuermann's kyphosis, Calvé disease, idiopathic juvenile kyphosis of the spine. These are all names that refer to a disease of the spine, which begins in childhood and affects up to a fifth of the population of adolescents.

The disease is more common among boys.

The spine is excessively bent, in the sense of hyperkyphosis, which is associated with pain and other difficulties.

In children, it is possible to confuse the disease with postural hyperkyphosis.
If the disease is neglected, it can be the cause of difficulties at a later age. Long-term difficulties are subsequently caused by various symptoms, which depend on the degree and place of damage to the spine.

For a better understanding, it is useful to know the basic information about the spine.

The Spine Is...

We have the spine more physiologically, ie naturally bent. This bending is of great importance in the formation of posture, stability and balance of the body, movement and also in dampening physical forces during daily activities.

The curvature of the spine is also known as an S-shaped bend. These are:

1. kyphosis - abnormally excessive convex curvature of the spine
   • in the thoracic and sacral regions
2. lordosis - abnormal inward curvature of the lumbar spine
   • the lumbar and cervical regions of the human spine
3. scoliosis - a sideways curve
   • which is present to a small extent up to 10 degrees in every person
   • it the angle is above 10°, it is already a diseased spinal deflection

Hyperkyphosis is excessive anteroposterior deflection of the spine. It most often affects the thoracic spine. It is evaluated with a deviation of more than 40 degrees.

Hyperlordosis is an excessive curvature of the part of the spine forward, in terms of anteroposterior deviation. Thus, the angle of curvature of the spine and pelvis increases. It occurs in the cervical and lumbar region.

Scoliosis is a type of abnormal spinal deflection to the side by more than 10 degrees. It can have 4 degrees and is the cause of various difficulties, which depend on the degree and extent of spinal damage.

The spine supports the body, carries the weight of the body and protects the spinal cord, which nervously connects the brain to the rest of the body.

Its main functional unit is the vertebrae, intervertebral joints, intervertebral discs, ligaments and spinal muscles, more precisely paravertebral muscles.

The spine contains 33 to 34 vertebrae and 23 pre-sacral vertebrae, as follows:

• 7 cervical vertebrae - vertebrae cervicales - C1 to C7
• 12 thoracic vertebrae - vertebrae thoracicae - Th1 to Th12
• 5 lumbar vertebrae - vertebrae lumbales - L1 to L5
• 5 or 6 sacral vertebrae - vertebrae sacrales - S1 to S5 (S6), ktoré spolu tvoria krížovú kosť, čiže os sacrum
• 4 or 5 coccygeal vertebrae - vertebrae coccygeae - Co1 až Co4 (Co5)
• intervertebral discs are located from vertebrae C2 - C3 to L5 and S1

Together, these structures provide life with the necessary movement that makes us self-sufficient.

Learn more about vertebrae, intervertebral discs and associated diseases in the following articles: 
Spinal disc herniation - an injury to the cushioning and connective tissue between vertebrae. 
Osteochondrosis - degenerative diseases of the joints. 
Spondylosis - degeneration of the vertebral column. 
Spondyloarthrosis - any joint disease of the vertebral column. 

Scheuermann'd Disease

The disease was first described by physician Holger Werfel Scheuermann in 1921 on the basis of an X-ray.
However, it is believed that the first one to do that was actually Stafford as early as 1832.
The first definition and diagnosis was given in 1964 by Sorensen.

The disease is defined as:

Scheuermann's disease, juvenile kyphosis, is a structural defect of the spine that affects at least three adjacent vertebrae and are altered by more than 5 degrees. The change in angle is caused by the pathological shape of the vertebrae.

The shape of the vertebral body forms a characteristic wedging.

Question:

Why is it referred to as juvenile or adolescent kyphosis?

Juvenile = young, child-like, occurring in youth, immature.
Kyphosis = excessive convex (bulging outwards) curvature of the spine. 

The disease is reported to affect 8 to 20 percent of children and adolescents aged 12 to 18 years.
The disease is more common among boys.
The severe form affects only about 1 percent of those affected.

It mostly develops in the thoracic region of the spine.
Scoliosis is also associated with hyperkyphosis in about 25%.
It is most commonly found the part between vertebrae Th7 and Th10.
It is less common in the section Th4 and Th6 or in the transition Th and L.
The most severe form affects the entire thoracic spine and the transition to the lumbar spine and its upper part.

Wedge-shaped vertebrae + deepened thoracic kyphosis = presence of a round back to visible hump.

The causes of the disease are still unclear.

A multifactorial basis is assumed. The basis is a genetic predisposition, which is supported by family occurrence. The degree of heredity has also been confirmed in several studies.

However, these are all just assumptions. Over the years, several theories have been developed, none of which have determined the exact cause of the disease.

Example:
Theory of premature termination of vertebral development with onset of deformation and wedge-shaped formation.

Another one:
The claim about the influence of herniation of the intervertebral disc into the body of the vertebra and the formation of Schmorl's nodes, in connection with the deformation of the vertebrae. Dr. Schmorl put forward this theory.

Furthermore, osteoporosis, i.e. thinning or deterioration of bone tissue, is said to be involved in the development of the disease.

The disease occurs in childhood and adolescence between the ages of 13 and 16, with the described onset beginning as early as the 10th year.

And this fact is supported by the explanation that the cause is too rapid development and growth of the body. It is a state of imbalance, the action of pressure, when the growth of soft structures precedes the growth and ossification (laying down new bone material) of vertebrae. Which leads to their deformation.

Table: Multifactorial effects and risk effects

The disease can occur at the age of 8 to 12 years of age.

That is, in the period before or during puberty.
The peak culminates in the fixation of changes between the ages of 16 and 21.

This is also the period of fixation, the so-called maturation, of the spine.

Deformation of the vertebrae visible on X-ray is present. This is in the form of wedge-shaped vertebrae, when the front part of the vertebral body is lowered compared to the back surface.

The intervertebral discs are irregular, narrowed. The cause is also damage to the end plate, ie the space at the vertebra-disk interface. The formation of Schmorl's nodes is typical.

Schmorl's node is a type of disc herniation towards the vertebral body.

Damage to the anterior part of the vertebrae causes a pathological bending of the spine ansd may also cause a visible hump. Most often at the level of thoracic vertebrae Th7 to Th10.

According to reports...

The anteroposterior curvature is also associated with a sideways curve, i.e. scoliosis.
= 25 % of cases.

Symptoms:

• excessive thoracic kyphosis = hyperkyphosis or a hump - thoracic gibbus deformity
  • deepening of the thoracic spine
• limitation of mobility and flexibility of the spine
• exertional back pain, after difficult physical activity
• pain when sitting or standing for a long time
• the pain also stems from a muscle imbalance
  • increase in tension or weakening
    • muscles of the torso, the back and lower limbs
    • weakening of the interscapular muscles
    • shortening of pectoral muscles
    • upper and lower cross syndrome, as we state in the article on kyphosis and lordosis
• pain between the shoulder blades, pain in the neck, shaft and hips
  • the pain can be pressure or acute with radiation
• incorrect posture
• forward tilt of the head
• sunken shoulders
• increased cervical and lumbar lordosis - compensation
• imbalance of the muscles of the back, abdomen, pelvis and lower limbs

The spine is fixed in the specified period of time, and after the end of the growth, the deformation of the vertebrae does not increase. Diseased vertebrae and a deformed spine in a pathological position, if the disease is overlooked and not treated in time, are the cause of various difficulties in adulthood, in the case of severe form and varying degrees of disability.

Risk complications of the disease:

• chronic back pain in adulthood
• neurological problems, with a more severe degree of disability
  • radiculopathy -  compression of the spinal nerves or spinal cord
  • myelopathy
• cardiac-pulmonary complications
  • uncommon
  • have been described with a severe degree of deformation above 100°
  • the reason is a change in the conditions in the chest cavity, which affects the heart, large blood vessels and lungs
• aesthetic changes
  • presence of a humped back
  • forward tilt of the head
  • sunken shoulder
  • hyperlordosis of the lumbar spine

Different methods are used in diagnosis, for example medical history, clinical picture and a neurological examination. Posture, posture, movement pattern, forward bend and spinal mobility in general (static and dynamic spine tests) are assessed.

Imaging techniques are also important.

The basis is X-ray. Subsequently, CT or MRI will help in the evaluation of soft structures.

The X-rays show changes in the shape of the vertebrae, the wedge-shaped shape, the narrowing of the intervertebral spaces, the presence of Schmorl's nodes.

In general, the disease is identified if there is a wedge deformation above 5° in 3 adjacent vertebrae and a deformation above 40° in kyphosis.

In this case, the Cobb measurement is known, similar to scoliosis. In most cases, it co-occurs with kyphosis.

Differential diagnosis, i.e. finding and distinguishing the cause of difficulties from other diseases, such as:

• axial spondylarthritis and ankylosing spondylitis
• postural kyphosis - poor posture
• scoliosis
• tumour, tuberculosis of the spine and others

The disease begins in childhood. Therefore, it is also referred to as juvenile kyphosis.

Stages of Scheuermann's Disease

There are two ways to grade the disease in the medical literature.
Firstly, the disease has a latent phase, an first-episode phase and a late phase.
Secondly, the disease has a prodromal stage, a fluoride stage, a repair stage and a resting stage.

The course of the disease depends on the extent and location of the spinal cord injury. As it develops as a child, the symptoms may be accentuated during school hours.

Long-term sitting is a problem for the student. Therefore, it should be able to change position. Appropriate activity and intensity are essential to alleviate complications.

It is inappropriate to overload the spine with certain physical activities, such as jumping, strengthening, and thus lifting heavy loads, or one-sided back loading and inactivity.

Unilateral and excessive loading of the spine leads to:
The negative development of deformations and the occurrence of complications.
And at any stage or age.

It is necessary to think about strengthening the muscle corset, which helps to hold the body properly.

In the case of the mild form, an asymptomatic course of the disease is possible, even in the case of a late phase. One does not have to feel any difficulties.

Women may have problems during pregnancy. So to increase the load on the spine.

The opposite is a difficult course when a higher extent of spinal cord injury is present. Then there is the risk of association with other neurological or cardiac-pulmonary disorders.

In the long run, it is possible to assume overloading of the muscles and parts of the neck and shaft. And precisely because of the present muscle imbalance. This results in problems arising from these areas.