Back pain

Scheuermann's disease is notorious for causing

lower and mid-level back pain, which can be

severe and disabling. The sufferer may feel pain

at the apex of the curve, which can be aggravated

by physical activity and by long periods of

standing or sitting; this can have a

significantly detrimental effect to their lives

as their level of activity is curbed by their

condition and they may feel isolated or uneasy

amongst their peers if they are children,

depending on the level of deformity.

In addition to the pain associated with

Scheuermann's disease, many sufferers of the

disorder have loss of vertebral height, and

depending on where the apex of the curve is, may

have a visual 'hunchback' or 'roundback'. It has

been reported that curves in the lower thoracic

region cause more pain, whereas curves in the

upper region present a more visual deformity.

Nevertheless, it is typically pain or cosmetic

reasons that prompt sufferers to get help for

their condition. In studies, kyphosis is better

characterized for the thoracic spine than for the

lumbar spine.

The cause is not currently known, and the

condition appears to be multifactorial.

Several candidate genes (such as COL1A2, which

has been associated with Marfan syndrome) have

been proposed and excluded.

[edit]Conservative treatment

Scheuermann's disease is self-limiting after

growth is complete, meaning that it generally

runs its course and never presents further

complication. Typically, however, once the

patient is fully grown, the bones will maintain

the deformity. For this reason, there are many

treatment methods and options available that aim

to correct the kyphosis while the spine is still

growing, and especially aim to prevent it from

getting any worse.

While there is no explanation for what causes

Scheuermann's Disease, there are ways to treat

it. For decades there has been a lot of

controversy surrounding treatment options. For

less extreme cases, manual medicine, physical

therapy and/or back braces can help reverse or

stop the kyphosis before it does become severe.

Because the disease is often benign, and because

back surgery includes many risks, surgery is

usually considered a last resort for patients.

However in severe or extreme cases sometimes

patients may be treated through an extensive

surgical procedure, in an effort to prevent the

disease from worsening or harming the body.

In Germany, a standard treatment for both

Scheuermann's disease and lumbar kyphosis is the

Schroth method, a system of specialized physical

therapy for scoliosis and related spinal

deformities.The method has been shown to

reduce pain and decrease kyphotic angle

significantly during an inpatient treatment

program.

Scheuermann's disease

Scheuermann's disease (pronounced 'Shoy-eh-ah-
man' though very often mispronounced as

'Sherman') is a self-limiting skeletal disorder

of childhood. It is also known as Sherman's

Disease, Scheuermann's kyphosis (since it results

in kyphosis), Calvé disease and Juvenile

Osteochondrosis of the Spine. It is named after

Holger Werfel Scheuermann. Scheuermann's

disease describes a condition where the vertebrae

grow unevenly with respect to the Sagittal plane;

that is, the anterior angle is often greater than

the posterior. This uneven growth results the

signature "wedging" shape of the vertebrae,

causing kyphosis.

Scheuermann's disease is considered to be a a

form of juvenile osteochondrosis of the spine. It

is found mostly in teenagers and presents a

significantly worse deformity than postural

kyphosis. Patients suffering with Scheuermann's

kyphosis cannot consciously correct their

posture. The apex of their curve, located in the

thoracic vertebrae, is quite rigid.

 

 

The seventh and tenth thoracic vertebrae are most

commonly affected. It causes backache and spinal

curvature. In very serious cases it may cause

internal problems and spinal cord damage, but

these cases are extremely rare. The curvature of

the back decreases height, thus putting pressure

on internal organs, wearing them out more quickly

than the natural aging process; surgical

procedures are almost always recommended in this

case.

Comorbid Conditions

Many with Scheuermann's disease often have an

excessive lordotic curve in the lumbar spine;

this is the body's natural way to compensate for

the kyphotic curve above. Interesting, many with

Scheuermann's disease have very large lung

capacities and males often have broad, barrel

chests. Most people have FVC scores above

average. It has been proposed that this is the

body's natural way to compensate for a loss of

breathing depth.

Often patients have tight hamstrings, which,

again, is related to the body compensating for

excessive spinal curative, though this is also

debated (for example, some suggest the tightness

of ligament is the initial cause of the growth

abnormality). In addition to the common lordosis,

it has been suggested that between 20-30% of

patients with Scheuermann's Disease also have

scoliosis, though most cases are negligible. In

more serious cases, however, the combination is

classified as a separate condition known as

kyphoscoliosis.

 

Successfully corrected

Scheuermann's disease can be successfully

corrected with surgical procedures, almost all of

which include spinal fusion and hardware

instrumentation, i.e., rods, pedicle screws, etc.

While many patients are typically interested in

getting surgery for their correction, it is

important to realize the surgery aims to reduce

pain, and not cosmetic defect. As always,

surgical intervention should be used as a last

resort once conservative treatment fails or the

patient's health is in imminent danger as any

surgical procedure is not without risk; however,

the chances of complication are relatively low

and the surgeries are often successful.

One of the largest debates surrounding

Scheuermann's disease correction is the use of

very different correction procedures. There are

different techniques to correct kyphosis; usually

the differences being posterior/anterior entry or

posterior entry (rear) only. The classic surgical

procedure partially entails entering two titanium

rods, each roughly one and a half feet long, into

the back on either side of the spine. Eight

titanium screws and hardware are drilled through

the bone and secures them in place onto either

side of the spine. On the internal-facing side of

the spine, ligaments (which can be too short,

pulling the spine into the general shape of

kyphosis) must be surgically cut or released, not

only stopping part of the cause of the kyphosis,

but also allowing the titanium rods to pull the

spine into a more natural position. Normally, the

damaged discs between the troubled vertebrae

(wedged vertebrae) are removed and replaced with

cartilage from the hip or other parts of the

vertebrae, which once healed or 'fused' will

solidify. The titanium instrumentation holds

everything in place during healing and is not

necessary once fusion completes. Recovery begins

in the hospital and depending on whether the

operation is one or two stage the patient can

expect to be in hospital for minimum of a week

possibly longer depending on recovery. They will

then often be required to wear a brace for

several months to ensure the spine heals

correctly leaving the patient with the correct

posture. The titanium instrumentation can stay in

the body permanently, or be removed years later.

Patients undergoing surgery for Scheuermann's

disease often need physical therapy to manage

pain and mobility, however their range of motion

is generally not limited very much. Recovery from

kyphosis correction surgery can be very long;

typically patients are not allowed to lift

anything above 5 of 10 pounds for 6 months to a

year. Many are out of work for at least 6 months.

However, once the fusion is solidified, most

patients can return to their usual lifestyle with

one to two years.

 

Advisable not to carry mattresses, especially up

stairs due to the increased strain on the

ligamentum flavum predisposing to discopathy.

Complications Spinal fusion for kyphosis and

scoliosis is extremely invasive surgery. The risk

of undergoing spinal fusion surgery for kyphosis,

like in scoliosis is estimated to be 5 % .

Possible complications may be inflammation of the

soft tissue or deep inflammatory processes,

breathing impairments, bleeding and nerve

injuries. However, according to the latest

evidence the rate of complications is beyond that

rate. As early as five years after surgery

another 5% require reoperation and today it is

not yet clear what to expect from spine surgery

in the long-term. Taking into account

that signs and symptoms of spinal deformity

cannot be changed by surgical intervention,

surgery remains to be a cosmetic indication.

Unfortunately the cosmetic effects of

surgery are not necessarily stable.] In case

one decides to undergo surgery a specialized

centre should be preferred.

 


External links:

http://orthoinfo.aaos.org/fact/thr_report.cfm?

Thread_ID=247&topcategory=Spine
http://www.back.com/causes-developmental-

scheuermann.html

http://www.emedicine.com/pmr/topic129.htm]
Scheuermann's Kyphosis (Scheuermann's Disease):

Abnormal Curvature of the Spine
http://www.allaboutbackandneckpain.com/html/spine

sub.asp?id=27

 

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