yogabook / pathologie / scheuermann’s disease

Scheuermann’s disease (osteochondritis deformans juvenilis dorsi, adolescent kyphosis, juvenile kyphosis)

Definition of

The earlier view that it was a case of aseptic bone necrosis of the vertebral bodies has largely survived; today it is assumed to be a disorder of vertebral body growth caused by excessively prolonged pressure on the ventral area of the vertebral bodies, which occurs as a result of prolonged sitting in a bent position or similar situations and activities, and which is increased and intensified as a result of rapid growth and weak back muscles. The diagnosis is made from a Cobb angle of 40° and at least three adjacent vertebrae, each with a 5° wedge shape. There are two types, the common thoracic type 1 and the rarer lumbar type 2:

1. Type 1: Hyperkyphosis of the thoracic spine with a tendency to hyperlordosis of the lumbar spine and hyperlordosis of the cervical spine
2. Type 2: Steep thoracic spine with tendency to steep lumbar spine or even kyphosis and steep cervical spine

Damage occurs to the upper and base plates, particularly in the lower thoracic spine, so that the vertebral bodies grow more slowly and wedge-shaped under pressure. Lentil- to pea-sized caverns develop in the damaged upper and base plates, which fill with intervertebral disc material, Schmorl’s nodules. In severe cases, the upper plates collapse. Affects mainly the thoracic spine, especially in the 10th-16th/18th year of life, boys 2-3 times more frequently, preferably affects fast-growing people. This is the most common spinal disorder. The long-term pain prognosis of type 2 is less favorable than that of type 1. In type I, the thorax presumably absorbs some of the change in statics. The uneven growth processes in Scheuermann’s disease favor the development of scoliosis. Once a diagnosis has been made, treatment should be carried out quickly and appropriately because the final shape of the spine in adulthood
spine in adulthood can change for the worse until the end of the growth phase or can be positively influenced by intervention.
can be positively influenced by intervention. The physiological curvature measurements of the spine are:

1. LUMBAR SPINE (L1-L5): -35° – -55°
2. Thoracolumbar (Th10 – L2): – 10° – + 10°
3. BWS (Th4 – Th12): 20°-40°

The description below applies to type I

ICD M42

Cause

1. Increased release of growth hormones and rapid length growth
2. Metabolic disorders in the area of the collagen fibers, especially on the vertebral cover and base plates; leads to the formation of inferior bone tissue

Predisposing

– Behavior

1. Long, bent sitting
2. Sports with compression and torsional stress on the spine

– Musculoskeletal system

1. Weak back muscles

– Other factors

1. familial disposition
2. Hypovitaminosis
3. Being overweight worsens the prognosis

Diagnosis

1. X-ray: wedge vertebra (at least three adjacent vertebrae with at least 5°), Schmorl’s nodules, Edgren-Vainio sign: increased bone growth in the top plate opposite a Schmorl’s nodule, Cobb angle, narrower intervertebral space. Careful diagnosis and documentation of values for prognosis of progression
2. Laboratory: Blood: – (BSG usually normal)
3. The straightening of the kyphosis in slipped posture and deep slipped posture are reference values for the conservatively achievable treatment results
4. Tests: Schober, Ott

Symptoms

1. increasing deformation, especially in the ventral area, due to increased strain:
2. X-ray highlight: Breaks in the cover and base plates, which leads to the next highlight:
3. Scheuermann’s triad: wedge vertebrae, Schmorl’s nodules, hyperkyphosis of the thoracic spine
4. Development of a rounded back, poor posture, apparent excess length of the arms
5. Back pain only in 10-15% of cases during the active phase, but more frequently in adulthood in post-Scheuermann’s syndrome (long-term increase in the hump)
6. The following does not apply here: the more pronounced, the more severe the pain. The disease usually burns out after the age of 18 and comes to a standstill; after 10-20 years, problems usually develop in the lumbar spine area in the form of paravertebral myogelosis or an increased tendency to protrusion and prolapse
7. possibly barrel vortex (excessive height) in the lumbar spine
8. possibly hyperlordosis of the lumbar spine
9. Reduced rotational ability of the WS
10. Strong psychological stress due to the aesthetic aspect
11. Rather weak back muscles
12. Improvement in back pain at rest

Complications

1. Post-Scheuermann’s syndrome: protrusion, prolapse in the lumbar spine (especially type 1), radicular symptoms, disc hernias
2. Lysis of the vertebral arches resulting in spondylolisthesis
3. Post-Scheuermann’s syndrome: osteochondrosis, premature spinal degeneration, further deterioration of the Cobb angle of the thoracic spine kyphosis
4. in severe cases: Restriction of breathing, possible impairment of heart and lungs
5. Chronic back pain

Therapy

1. Gymnastics, postural gymnastics, training of the back muscles, stretching of the chest muscles, posture training.
2. in the active phase: avoid compression and rotational stresses caused by impacts, jumps, blows, falls and sports that involve these, e.g. martial arts (judo, wrestling), indoor ball sports, apparatus and floor gymnastics, cycling in racing bike position, running on hard surfaces with insufficient cushioning; there are also signs against competitive rowing
3. in the active phase: stomach sleep on a hard mattress
4. Sports such as weight training (without lifting and pushing loads), swimming, gymnastics, walking, horse riding are indicated
5. if PT and other muscular measures are not successful: Orthoses with temporary overcompensation (Milwaukee brace)
6. If necessary, surgery(spondylodesis from rod implants), usually only after the growth phase has been completed and only if at least one of the criteria is met:
7. For pain: paracetamol, ibuprofen

DD

1. Osteoporosis
2. Ankylosing spondylitis
3. infectious spondylitis
4. Osteogenesis imperfecta
5. Rickets
6. Hyper-PTH, Hypo-PTH
7. Tumors
8. Traumatic damage to the spine
9. Neurofibromatosis