Scheuermann's Kyphosis is a developmental disorder that causes patients to have a stooped posture due to an excessive curve in the thoracic spine. The thoracic spine normally has a slight contour called kyphosis which is exaggerated in Scheuermann's disease. It is a self-limiting condition that presents in the adolescent years, usually at the end of the growth spurt. It affects between 0.5% and 0.8% of the population and is more prevalent in males.
The cause is not yet known but is hypothesized to be a genetic condition which causes an abnormal development of the vertebral end plate. This is suggested to result in a decreased growth of the front of the vertebral bodies leading to a wedging of the vertebral bodies.
The appearance of Scheuermann's disease is a deformity most commonly seen in the thoracic spine which cannot be consciously corrected. On bending forward a hump called gibbus is often seen. Three to five segments are commonly affected and the seventh to tenth thoracic segments are commonly involved. The apex of the curve may often be an area of pain or it can even cause lower backache due to strain on other more flexible parts of the spine. The person loses height due to the forward stoop and might be heavier set due to more weight around the intestines. This can make children uneasy as they appear fatter than their peers. In very serious cases there might be spinal cord and internal organ damage due to compression.
Postural kyphosis vs Scheuermann's kyphosis
It is important to make a differentiation between postural kyphosis and Scheuermann's kyphosis. While postural kyphosis can be consciously corrected and shows no changes on an X-ray, Scheurmann's is rigid and shows characteristic X-Ray findings. The vertebral bodies show an anterior wedging with irregular and herniated disc. A hallmark in the diagnosis is the presence of Schmorls nodes which are disc bulges within the vertebral body. A hyperextension X-Ray is taken in lying down with a bolster extending the apex of the curve. This determines the extent to which the spine can be straightened out.
Treatment of Scheuermann's Kyphosis depends on several factors, including the age of the pateint, the severity, the presence of pain and associated symptoms. If the patient is young and has no symptoms other than a physical deformity, he can be managed quite well with physiotherapy. This includes exercises for strengthening and mobility/flexibility. A regular clinical examination is advised to monitor the progress of the curve. Adult patients presenting with pain can be managed with physiotherapy too if the pain is not serious and lung function is not compromised. Often a brace is prescribed to patients. Hamstring stretches, spinal mobility exercises, postural correction and cardio exercises are used in the treatment of patients.
Surgery is the last resort if conservative treatment fails, or there is rapid worsening of the curve, or there is an imminent health risk like decreased lung function. The surgical procedure will involve the use of a set of titanium rods with screws on either side of the spine to achieve straightening of the spine.