Scheuermann's disease
introduction
Scheuermann's disease, a growth disorder occurring in adolescence on the base and cover plates of the vertebral bodies of the thoracic and / or lumbar spine with increased kyphosis or reduced lordosis (decrease or increase in the physiological oscillation of the spine). At least three adjacent vertebral bodies must be affected, each with a wedge angle of at least 5 degrees. The name Scheuermann's disease comes from the Danish radiologist and first person to describe this disease, H. W. Scheuermann (1877-1960) back. There are many synonyms, including juvenile kyphosis, adolescent kyphosis, postural kyphosis, and adolescent hunchbacks.
root cause
The cause of the M. Scheuermann is not known.
Mechanical and genetic factors with a reduced capacity of the vertebral body, abnormalities of the vertebral body marginal ridges, intervertebral disc tissue that gets into the vertebral bodies, as well as vitamin deficiency syndromes, etc. can play a role.
The X-ray shows the formation of a wedge-shaped vertebra and so-called Schmorl's nodules, which represent intervertebral disc tissue that has penetrated the vertebral body.
Ultimately, an imbalance occurs in the growth of the anterior and posterior parts of the vertebral body, which leads to the formation of wedge-shaped vertebrae.
Clinical and radiological changes can occur from the age of 11. The typical disease changes in the vertebral bodies are stabilized at the end of growth. Secondary phenomena due to the kyphotic spinal column malalignment can also show up later.
In particular, performing strenuous sports in adolescence can result in a Scheuermann's disease favor. Performance gymnasts are to be mentioned here in particular.
A Scheuermann can rarely be based on a connective tissue disorder (collagen).
The occurrence especially during the puberty allows the conclusion that the disease is hormonal. Many bone growth disorders, such as of the Perthes disease occur during puberty.
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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.
The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
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Epidemiology
Scheuermann's disease is the most common spinal change in growing age. Not every illness is necessarily accompanied by symptoms or complaints. Scheuermann's disease can be detected in about 20-30% of all adolescents on the X-ray, only a small proportion develop symptoms.
4 - 6% of the total population are affected. The gender ratio is male: female = 2: 1. The typical age of onset is between 11 and 13. Age.
In most cases, the Scheuermann affects the thoracic spine, less often the lumbar spine. If it is affected at the same time, it is called a thoracolumbar scrub.
Symptoms
As with many diseases, there are no clear symptoms that indicate Scheuermann's disease. Often, diffuse back pain is in the foreground in the early stages.
Read more on the topic: pain in the back
Scheuermann's disease typically develops in three stages:
Initial stage:
Usually there are no symptoms during the first stage of Scheuermann's disease. In most cases, this stage is only recognized in the X-ray.
Training stage:
During the second stage of Scheuermann's disease, pain increases. Deformations form on the vertebral bodies. Due to the formation of a wedge-shaped vertebra, a so-called rounded back can form in the thoracic vertebral column area, and a so-called flat back in the lumbar vertebral column area.
Final stage:
Pain is most common in the terminal stages. The deforming growth process is complete. The malformation of the vertebral bodies overloads the adjacent structures, such as ligaments, vertebral joints and muscles. Long-term overload causes premature wear and tear and thus arthritis of the spine (degenerative changes).
The consequences of the disease can be:
- Hunchback in the thoracic spine
- Flat back in the lumbar spine
- Limited mobility in flexion and rotation
- In around half of all cases, back pain occurs predominantly in the thoracic spine.
- Disc problems and back pain, especially in the lumbar spine, can also occur later.
Pain
In most patients, the disease is usually painless in childhood and adolescence. Back pain, various muscle tension or additional damage to the spine only occurs in adulthood between the ages of 20 and 30. The reason lies in the long-term overloading of the shape-changed and growth-impaired vertebral bodies. In addition to the disease, a clear hollow back and a hunched back are often formed. These cause severe pain in both the arms and legs. Significant movement restrictions and stiffness in the entire spine can also be observed.
Therapy for Scheuermann's disease
Therapy goals
Therapy goals of Scheuermann's disease:
- Prevents the occurrence or progression of a severe spinal deformity
- Pain reduction or elimination
- Attempt to correct the spinal deformity
The treatment of Scheuermann's disease depends on the stage of the disease, as well as on the extent of the malformation and symptoms.
As long as the growth is not complete, a growth correction is theoretically possible. An improvement can be achieved through muscular stabilization.
In the case of mild illnesses of Scheuermann's disease, muscular stabilization that compensates for the postural damage in combination with movement exercises is certainly sufficient.
However, if a pronounced hunchback develops, a corset adjustment or straightening operation may be necessary. However, this can only be carried out after the growth phase has ended.
Changing many little things in everyday life can often lead to poverty or freedom from symptoms.
The ergonomics of your workplace is important with Scheuermann's disease, all work areas should be adjusted to be back-friendly.
A back school gives you lots of helpful tips in everyday life on how you can work in a way that is easy on your back. Muscular build-up and relaxation exercises that you can do several times a day “in between” are often very successful.
Proper application of all exercises is important here!
You can find further information under our topic: Back school.
Muscular stabilization should be achieved through intensive physiotherapeutic treatment of Scheuermann's disease. Shortened muscle groups need to be stretched.
Red light, massages and physical measures such as electrotherapy (TENS) can be used against muscular imbalances.
At the Scheuermann's disease stand in principle different types of therapy to disposal. Which of these makes the most sense for a particular patient depends on one Variety of individual circumstances (for example age, accompanying illnesses and personal preferences), but above all on the severity of Scheuermann's disease. Therefore a appropriate therapy for each patient individually and should therefore be discussed with a doctor in any case.
physical therapy
Of the most important therapy component at the Scheuermann's disease is the physiotherapy. Through the Curvature of the thoracic spine are the Chest muscles practically shortened and the Back muscles ineffective enough. Hence there is a physical therapy mainly of two components: the Back muscles needs to be strengthened to straighten the back and the Abdominal muscles needs to be stretched.
In addition, the spine should be exercised through other exercises kept mobile become. Such therapy should first be instructed by an experienced doctor or physiotherapist and then also performed regularly at home to show a benefit. Especially when a patient is still growing, physiotherapy is often sufficient as the only therapy for the Scheuermann's disease to manage.
Exercises
Physiotherapy exercises can delay the progression of the disease and alleviate the symptoms. These exercises should be learned under expert guidance and later continued independently at home.
Manual therapy
Manual therapy is used to eliminate functional disorders of the musculoskeletal system (joints, muscles and nerves). It is carried out by physiotherapists with special training. The symptoms are alleviated by means of targeted stretching, mobilization and relaxation exercises.
You can find more information about this form of treatment at Manual therapy.
Back corset
There is another possibility (especially with the Scheuermann's disease of the thoracic spine) in wearing one special corsetse.g. one Milwaukee corsets, which ensures that the Spine is raised.
So a Treatment success However, it is important to have this corset Worn almost the entire day in the beginning and is only removed for personal hygiene. Later it is often enough when the corset only dressed overnight becomes.
The problem here is that many children and young people are annoyed or at least afraid of wearing a corset and therefore do not put it on regularly. If a corset is worn, in regular visits to the doctor to check whether the corset is still in place and to adjust it if necessary.
Medication
Usually Scheuermann's disease prepares no pain. Occasionally, however, it can be due to the curvature of the spine Pinched nerves or incorrectly strained muscles which can lead to pain. In such a case there is a Treatment with pain medication (especially from the group of non-steroidal anti-inflammatory drugs, for example Ibuprofen) and or muscle relaxing drugs (Muscle relaxants).
Adjusting everyday life
In addition to all these therapy options are certain changes in everyday life makes sense.
So you should be careful with Scheuermann's disease to be physically active, mainly by Back-friendly sports such as swim or gymnastics. Sports that involve Violence on the back or Jumps / shocks go hand in hand, such as martial arts or long / high jump, should be avoided.
There is also one in Scheuermann's disease patients upright posture even more important than already. In addition, that will Lie on your stomach (while reading or sleeping) felt by many affected as pleasant. Especially with children / adolescents or other people who a lot of time at the desk it is advisable to spend the Height of table and chair adapt so that a back-friendly seat height is achieved.
Surgery for Scheuermann's disease
Only in a few cases is one in Scheuermann's disease operative therapy necessary. For example, an operation is performed when
- chronic pain that does not respond to conservative therapy is present
- the lung function is impaired
- there is strong psychological stress due to a pronounced form of Scheuermann's disease
Here must Risks and Benefits of Surgery must of course always be carefully weighed against each other. However, the prerequisite for the decision to undergo surgery is always that the Growth phase already completed is.
In an operation for Scheuermann's disease, first Discs removedthat are worn out. The resulting gaps are through the body's own bone material is replenished. Then be Metal plates and screws drilled into the spine so this erect and stabilized and remains in this position. It is often recommended for after such a procedure to wear a corset for a few weeks or monthsto aid the spine and healing.
Which sport is recommended?
To counteract deterioration, the back muscles should be strengthened and the mobility of the spine promoted. Joint-gentle sports such as swimming, yoga, Pilates and relaxation exercises are recommended. In addition, back exercises and / or specific strength training should be done regularly. Especially in adolescence it is important to train the back, abdominal and core muscles through sport. This protects muscles, bones, intervertebral discs, tendons and cartilage from further damage and injuries.
Is there a higher risk of a slipped disc?
Due to the pathological change in shape of the vertebral bodies, there is constant excessive and incorrect loading of the intervertebral discs. As a result, these change their position and location, become thinner or can recede entirely. Thus, the risk of developing a slipped disc in adulthood with Scheuermann's disease is significantly increased.
More on this: Long-term consequences of Scheuermann's disease
prophylaxis
Old methods mentioned in therapy can of course also be used for prophylactic purposes. A good muscular corset should be acquired in childhood so that symptoms cannot arise in the first place.
In particular, training the abdominal and back muscles, swimming (especially back swimming, no dolphins), avoiding competitive sports, not carrying or lifting heavy loads, reading in the prone position and an appropriate height and incline of the desk.
forecast
In most cases one prepares Scheuermann's disease no complaints and is only diagnosed as a chance diagnosis on the X-ray. Misalignments of the spine can cause chronic back pain or Herniated discs develop.
Permanent malpositions, which require surgical therapy in terms of severity, are usually the exception.
diagnosis
In the early stages of Scheuermann's disease, poor posture, mostly in the thoracic spine (hump formation), is noticeable.
Clinically, the diagnosis can be confirmed by demonstrating the fixation of the hunchback (inability to actively balance the hunchback).
If the x-ray shows the typical Scheuermann changes, the diagnosis can be made.
Changes in x-ray
In the case of Scheuermann's disease, clear changes in the shape of the vertebral bodies and their growth disorders can be recognized in the X-ray. In addition, a hunched back and a hollow back can usually be diagnosed due to the long-term excessive and incorrect loading of the spine. A three-dimensional twisting and bending of the spine (scoliosis) is usually visible. To determine the exact extent of the disease, the entire spine should be X-rayed from the front and the side.
Radiological changes in Scheuermann's disease are:
- typical Schmorl nodules (see white arrow, picture above)
- irregular top and base plates of the vertebral bodies
- Wedge vortex formation (see the two vertebral bodies above picture - upper vertebral bodies normal, lower wedge vertebrae)
- Edgren - Vaino - sign: nodules in the top or bottom plate opposite the Schmorl nodules
Wedge vortex formation in M. Scheuermann
The X-ray close-up shows the collapse of the cover plate of a vertebral body in Scheuermann's disease and the resulting wedge vertebrae.
Several such wedge vertebrae then lead to a hunched back.
