Eur Spine J. official website and that any information you provide is encrypted Moreover, Ogilvie and Sherman [16] suggested that pain in patients with Scheuermanns disease, when present, was generally mild and precipitated by prolonged periods of sitting or exercise and was frequently located near the apex of the deformity. (1) The thoracic kyphosis angle (T3T12) was measured using a modified Cobb method. Weiss HR, Dieckmann J, Gerner HJ. 2017. Although some studies report a male predominance, the literature is variable on this point.2. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, El-Feky M, Di Muzio B, et al. Studies on the association between the clinical and radiological features are also crucial. None of the patients were surgically treated; however, 21 patients were treated using a brace. Sachs B, Bradford D, Winter R, Lonstein J, Moe J, Willson S. Scheuermann kyphosis: follow-up of Milwaukee-brace treatment. 2011 Oct. 82(5):602-5. The associations of the Cobb angle of thoracic kyphosis and age, height, and radiological parameters are presented in Table 2. Scheuermanns disease is characterized by vertebral body wedging, vertebral endplate irregularity, diminished anterior vertebral growth, Schmorls nodes, narrowing of the intervertebral disk spaces, and premature disk degeneration [7]. (8) The thoracolumbar relative position: We evaluated the feasibility of a new radiological line for measuring the distance between the vertical axis of the L5 anterior vertebral body, the anterior border of the thoracic kyphosis apex vertebral body, and the L5 kyphosis apex line (L5-KAL). Objective: To determine the prevalence of radiographical Scheuermann disease in a Dutch population and evaluate the consistency of diagnostic criteria. 3. [9], who performed a survey study of 943 twins diagnosed with Scheuermanns disease. [3] indicated that patients with Scheuermanns disease had a higher risk of back pain than the controls. View Yuranga Weerakkody's current disclosures, View Mostafa El-Feky's current disclosures, see full revision history and disclosures. By K. Harry Srensen. Check for errors and try again. Clinical Appearances, Radiography, Aetiology, and Prognosis. Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans Ali RM, Green DW, Patel TC. As a library, NLM provides access to scientific literature. Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and RehabilitationDisclosure: Serve(d) as a speaker or a member of a speakers bureau for: Merz. The patients with one AWV comprised only 4% of the study cohort, with an average thoracic Cobb angle of 55. 12. Elizabeth A Moberg-Wolff, MD Medical Director, Pediatric Rehabilitation Medicine Associates Histologic changes demonstrate that vertebral growth endplate cartilage is abnormal, with a decreased collagen/proteoglycan ratio on electron microscopic examination. No statistically significant association was noted between the thoracic kyphosis and the C7 plumb line. J Med Genet. Heithoff K, Gundry C, Burton C, Winter R. Juvenile Discogenic Disease. 7th SOSORT consensus paper: conservative treatment of idiopathic & Scheuermann's kyphosis. Eur Spine J. Identification of features of SD and determination of the degree of kyphosis is helpful in determining operative vs. non-operative management. Whole spine mri Sagittal T1 Sagittal T2 Sagittal T1 Sagittal T2 Sagittal T2 Sagittal T1 69.) The etiology, prevalence, male-to-female ratio, and even the diagnostic criteria remain ambiguous, as detailed above. Scheuermann's kyphosis; current controversies. Frequencies of AWVs associated with the thoracic Cobb angle. Case study, Radiopaedia.org (Accessed on 05 Jun 2023) https://doi.org/10.53347/rID-168907, View Yazane Abdallah's current disclosures, see full revision history and disclosures. 2012;56(6):491-505. 2). 2019;39(1):287-8. spinal infection / inflammation / degeneration. [Full Text]. 9 (11):[QxMD MEDLINE Link]. Payne WK 3rd, Ogilvie JW, Resnick MD, Kane RL, Transfeldt EE, Blum RW. 1. Similarly, a recent study by Ristolainen et al. Kyphosis in children can also be associated with certain medical conditions, such as Ehlers-Danlos syndrome. This condition has been reported to occur in 0.4% to 8% of the general population, with an equal distribution between sexes. [10] stated that two or more adjacent apical vertebrae were adequate for the diagnosis, whereas Sachs et al. Radiographic measurements. Tsirikos AI, Jain AK. Gore DR, Sepic SB, Gardner GM. Conversely, other authors advocated different criteria. One possible explanation of this variability is that females may be more willing to wear a brace for the Scheuermanns kyphosis. Scheuermann's kyphosis: a condition that causes the vertebrae to curve forward in the upper back area; the cause of Scheuermann's kyphosis is unknown and is commonly seen in males. Methods: A literature-based narrative review of English language medical literature. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. The transitional zone angle was measured from the T10 superior endplate to the T12 inferior endplate and from the T12 superior endplate to the L2 inferior endplate. Summary of Background Data. The L5-KAL is a new radiological line that has not yet been reported in the literature that evaluates the relative position between the thoracic and lumbar spine. To evaluate the spinal radiological features in patients with Scheuermanns disease and the association between the thoracic kyphosis angle and clinical presentation. 2016. 2022 Jan. [QxMD MEDLINE Link]. All patients were diagnosed by board-certified orthopedic surgeons according to the definitions by Sachs et al. [7], who conducted a 32-year follow-up study of 67 patients with Scheuermanns disease, and Damborg et al. The thoracic segment was determined by counting the number of vertebrae from L5. Quiescent Schmorl nodes are extremely common found in around 75% of autopsies, at all ages, more frequently in males 9. [QxMD MEDLINE Link]. 2014 Oct 4. The self-perceived body image was significantly associated with the thoracic kyphosis angle, the number of AWV, and the L5-KAL. Check for errors and try again. Copenhague: Munskgaard: 1964. A comparison of three methods for measuring thoracic kyphosis: implications for clinical studies. The gas extrusion sign may be present which refers to hypointensity in the intervertebral disc space across all pulse sequences 10. The subjects in two previous studies had severe Scheuermanns disease and were candidates for surgery [4,19]. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. It is named after Christian Georg Schmorl (1861-1932), a German pathologist who first described them in 1927 9. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. In addition to the number of wedged vertebrae and the Cobb angle of thoracic kyphosis, various radiographic characteristics of Scheuermanns disease have been described. The X-ray images were obtained by specially trained technicians at the radiology departments of the Maccabi Health Care Services Centers. The disease usually emerges between late juvenile and 16 years of age, commonly between the ages of 12 and 15 years [13]. J Bone Joint Surg Br. Takahashi K, Miyazaki T, Ohnari H, Takino T, Tomita K. Schmorl's Nodes and Low-Back Pain. Scheuermanns kyphosis develops prior to puberty after the ossification of the vertebral ring apophysis, becoming the most prominent during the adolescent growth spurt as a structural kyphotic deformity of the thoracic or thoracolumbar spine [13]. We proposed two hypotheses. (6) The number and location of the anterior wedged vertebrae (AWV) only >5, consistent with the definition of Sachs et al. At the time the article was created Behrang Amini had no recorded disclosures. Acta Orthop. Values are presented as number (%). Spina bifida. Preoperative lateral of a patient with an 85 thoracic . 2002 Jan-Feb. 2(1):49-56. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, El-Feky M, Bell D, et al. Effect of intensive rehabilitation on pain in patients with Scheuermanns disease. The analysis of the associations between the clinical parameters (pain and self-perceived body image) and the radiological parameters is presented in Table 4. Kyphosis dorsalis juvenilis. These findings suggest that clinicians who treat patients with Scheuermanns disease based on radiological indices should also assess self-perceived body image, a parameter that is considered to be crucial in these patients. [28], who found that the sacrum was significantly more horizontally oriented in the patients with Scheuermanns disease compared with the control subjects. The NPRS showed a significant association only with SS (r =0.219, p =0.014). Excessive axial spine load due to heavy weightlifting may also contribute. 273, with 25 Figures and 95 Tables. Normal limits of cervical lordosis range from 20 to 35 for the C2C7 vertebrae [20]. Scheuermann's disease is a kyphotic deformity of the spine that develops in early adolescence. Hardacker JW, Shuford RF, Capicotto PN, Pryor PW. Corresponding author: Leonid Kalichman Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 9 X 6 In. Gustavel M, Beals RK. Results: Significantly more patients with Scheuermann's disease had at least one MC compared to the controls at the level L1/L2 (Odds Ratio [OR] 21.11, 95% Confidence Interval [95% CI] 2.31-192.96), at the level L3/L4 (OR 13.62, 95% CI 1.41-131.26), and at the level L5/S1 (OR 6.11, 95% CI 1.50-24.83). Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic PhysiatristsDisclosure: Nothing to disclose. Scheuermann's disease (SD), also known as Scheuermann's juvenile kyphosis or juvenile osteochondrosis of the spine, was first described by Holger Scheuermann in 1920. [11] and referred for conservative treatment in the posture clinic. 2018 Jul 17. Unable to process the form. [Operative treatment of severe spine deformities]. In 1964, Sorensen introduced the classic diagnostic criteria for SD of three consecutive vertebral bodies with anterior wedging of at least 5 degrees.5Additional imaging findings include endplate irregularities, commonly manifested as Schmorls nodes, lengthening of the vertebral bodies, and thoracic kyphosis with a Cobb angle of at least 40-45 degrees (measured by drawing intersecting vectors parallel to the superior endplate of the vertebral body at the top of the kyphotic curve and the inferior end plate of the vertebral body at the bottom of the curve) (Figure 3).6 Of note, the Cobb angle is more accurate when measured with computer assistance. The theories relating to Scheuermann's disease are reviewed. Please confirm that you would like to log out of Medscape. Talk to a doctor to learn if any imaging studies are suggested to diagnose or manage this disease. Lowe TG, Kasten MD. Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic MedicineDisclosure: Nothing to disclose. The vertebrae with the highest average Cobb angle were T11 (7.64), T7 (7.34), and L1 (7.33). HHS Vulnerability Disclosure, Help have demonstrated a significant genetic component, with suspected autosomal dominant transmission.3,4 Mechanical stress is generally accepted as a contributing factor, with increased incidence seen in athletes who participate in sports requiring significant flexion/extension, and in young manual laborers. J Bone Joint Surg Br. Scheuermann's disease. The radiological parameters were measured for intra-rater reliability that revealed the following: 0.98 for the thoracic kyphosis angle, 0.98 for cervical lordosis, 0.96 for lumbar lordosis, 0.93 for SS, 0.98 for the T10T12 Cobb angle, 0.99 for the T12L2 Cobb angle, 0.94 for the number of AWV, and 0.99 for the C7 plumb line and the L5 KAL line. Ater A et al. One-way analysis of variance was used for comparing continuous variables (age, height, thoracic kyphosis, cervical lordosis, lumbar lordosis, SS, pain, and body image) between the males and females, whereas Pearsons chi-square test was used for comparing the number of AWV and Risser sign between males and females. There is a strong hereditary predisposition (perhaps autosomal dominant)with a high degree of penetrance and variable expressivity. Pain was not substantial; however, self-perceived body image, the most common complaint of patients with Scheuermanns disease, was high and significantly associated with thoracic kyphosis and the number of AWV. Scoliosis. FOIA {"url":"/signup-modal-props.json?lang=us"}, Abdallah Y, Scheuermann's disease. Garrido E, Roberts SB, Duckworth A, Fournier J. Eur Spine J. Liu N et al. 5. In addition, the NPRS was previously shown to be a valid and reliable tool for assessing pain in Scheuermanns patients [3,18]. Presentation Kyphosis and back pain. -. On the basis of our experience, this zone is very sensitive to changes in the sagittal plane, especially during sports activities, and can play an important role in predicting the risk of kyphosis progression. James J. Scheuermann's Juvenile Kyphosis. 1 Prevalence and etiology: Scheuermann, or Scheuermann's, disease (juvenile kyphosis) is a deformity in the thoracic or thoracolumbar spine in which pediatric patients have an increased kyphosis along with backache and localized changes in the vertebral bodies. Spine J. 1994;19(3):335-40. The middle column displays the absolute number and percentage of anterior wedged (Cobb angle 5) vertebrae. [QxMD MEDLINE Link]. Sixty-three out of the 126 patients (50.00%) reported a positive family history of spinal deformities (at least for two generations), and 16 patients (12.69%) reported pediatric developmental disorders. At the time the article was last revised Joachim Feger had no recorded disclosures. Reference article, Radiopaedia.org (Accessed on 05 Jun 2023) https://doi.org/10.53347/rID-2022. [QxMD MEDLINE Link]. The normal angle of thoracic kyphosis (T3T12) ranges between 25 and 45 as measured using the Cobb method on a standing lateral radiograph, with the arms at 45 below the horizontal plane [12]. [11], which states that at least one wedged vertebra with a minimum angle of 5 and a thoracic kyphosis of >45 (T3T12) is present in patients with Scheuermanns disease. [QxMD MEDLINE Link]. The Cobb angle of thoracic kyphosis in males (60.728.18; range, 4683) was greater than in females (57.589.21; range, 4686; p=0.032). Jozef E Nowak, MD Consulting/Admitting Physiatrist, Division of Physical Medicine and Rehabilitation, Kelowna General Hospital Frequently, the pain subsides with the cessation of growth. AJNR Am J Neuroradiol. Signal loss is present in multiple intervertebral discs with associated endplate irregularity and Schmorls nodes. A Clinical Series and Classification. 11. For patients with a kyphosis of less than 80%, treatment is generally conservative, utilizing physical therapy and bracing, with a high rate of success. The duPont kyphosis brace for the treatment of adolescent Scheuermann kyphosis. Riouallon G, Morin C, Charles YP, et al. Somhegyi A, Ratko I. Hamstring tightness and Scheuermanns disease: commentary. What are the Indications for Spinal Fusion Surgery in Scheuermann Kyphosis?. The radiological reporting of lumbar Scheuermann's disease: an unnecessary source of confusion amongst clinicians and patients. 1995;4(1):56-9. [QxMD MEDLINE Link]. -. In their 32-year follow-up study, Murray et al. Scheuermann's disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine during adolescence period. [QxMD MEDLINE Link]. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzExOTU5LXdvcmt1cA==. 17.0 for Windows (SPSS Inc., Chicago, IL, USA). Scheuermanns disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine that affects adolescents. The pain symptoms, however, did not interfere with the activities of daily living or employment. 3. Scheuermann Disease: Evaluation of Radiological Criteria and Population Prevalence. The validity and reliability of the L5-KAL as well as its association with clinical findings will be evaluated in future studies. (3) The lumbar lordosis (L1S1) was measured using a modified Cobb method. Tribus CB. The mild positive association between the T10T12 Cobb angle and thoracic kyphosis demonstrates the direct association between these two areas, since T10T12 represents the lower part of the thoracic kyphosis curve. Rosendal T. Holger Werfel Scheuermann. 1990;72(6):940-5. encoded search term (Scheuermann Disease) and Scheuermann Disease. Numerous studies examining the psychological impact of scoliosis and kyphosis indicate that patients with scoliosis have a negative body image perception, are more likely to report being less healthy, are more worried that their body was abnormally developing, and exhibit a greater concern regarding the quality of peer relationships [29,30]. Diagnosis of Scheuermann's disease is suggested on clinical examination; however [Full Text]. [ 1, 2] See the image below. A limbus vertebrais closely related to a Schmorl node as well. 2008 May. Radiographics. Atypical SD has been used to describe patients who do not meet the classic criteria of three consecutive wedged vertebral bodies and kyphosis but have other features of SD (Figure 4); some advocate a definitive diagnosis of SD if endplate irregularities and at least one wedged vertebral body are present.8,9, A Sagittal T2-weighted image of the thoracic spine in this 21 year-old male reveals mild anterior wedging of the T8 vertebral body without significant associated kyphosis. The type of imaging study a doctor chooses depends on a patient's symptoms and the part of the body being examined. on lumbar magnetic resonance imaging (MRI), a greater prevalence of Modic changes at levels L1/L2, L3/L4 . 1. The first 15 X-ray images were examined twice, 2 weeks apart. The influence of sagittal cervical profile, gender and age on the thoracic kyphosis. Erkan S, Yercan HS, Okcu G, Ozalp RT. The following data were collected from the medical files of the patients: age, sex, height (measured in a natural standing position by a Seca altimeter; Seca, Hamburg, Germany), family history (positive/negative), pediatric developmental disorders (positive/negative), Risser sign (05, derived from the anteroposterior view of the pelvis), self-perceived body image (rated by the Numeric Rating Scale [NRS] from 0 to 10 [from satisfied to very dissatisfied with appearance] and the previous weeks back pain rated by the Numeric Pain Rating Scale [NPRS]). Results of Pearson correlation analyses (univariate) between thoracic kyphosis and age, sex, height, and radiological parameters. Peleg S, Dar G, Steinberg N, Masharawi Y, Hershkovitz I. Sacral orientation and Scheuermanns kyphosis. 8. They also found that the mean Cobb angle of lordosis in T12L2 was 3, ranging from 23 lordosis to 13 kyphosis [12]. 2. Note that kyphosis is not a prominent feature. To correct this, surgery may be needed. These findings do not meet the classic diagnostic criteria for Scheuermanns disease, but could be described as atypical Scheuermanns disease., A second type of SD has been described, affecting the thoracolumbar junction or the lumbar spine, referred to as lumbar Scheuermanns, Type 2 Scheuermanns, or Scheuermann-like disease;10 although anterior wedging of vertebral bodies and endplate irregularities are seen, thoracic kyphosis may not be a prominent feature (Figure 5).11. Gocke E, Beyhan M. Radiological imaging findings of Scheuermann disease. Laur O, Mandell J, Titelbaum D, Cho C, Smith S, Khurana B. A Sagittal T2-weighted image of the lower thoracic and lumbar spine in this 15 year-old female shows anterior wedging of the T11, T12, and L1 vertebral bodies, with associated endplate irregularity from T11 to L2. 3. An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermanns disease: a review of 32 patients. See Identifying Incorrect Posture As part of a thorough exam, the doctor typically observes the young person in a variety of positions and assesses the range of motion. We found a moderate positive correlation between the Cobb angle of thoracic kyphosis and the L5-KAL. Vestn Ross Akad Med Nauk. On imaging, affected individuals can have vertebral endplate changes, disc space narrowing, and anterior Schmorl nodes, but not otherwise fulfilling Sorensen criteriafor the Scheuermann disease 2. Inclusion in an NLM database does not imply endorsement of, or agreement with, 2008 Feb 16. Children (Basel). Blumenthal SL, Roach J, Herring JA. Significant positive associations were observed between the NRS for self-perceived body image, the thoracic kyphosis (r =0.494, p <0.001), and the number of AWV (r =0.361, p <0.001). American Academy of Physical Medicine and Rehabilitation, College of Physicians and Surgeons of British Columbia, Royal College of Physicians and Surgeons of Canada, American Association of Neuromuscular and Electrodiagnostic Medicine, American Academy for Cerebral Palsy and Developmental Medicine. Lorente A, Barrios C, Lorente R, Tamariz R, Burgos J. Although the pain was not substantial in the study cohort (NPRS, <3 out of 10 in both the males and the females). To investigate the relationship between radiological signs of Scheuermann disease (SD) and low back pain (LBP) in a local population using lumbar magnetic resonance (MR) images. Bezalel T, Carmeli E, Been E, and Kalichman L. Scheuermanns disease: Current diagnosis and treatment approach. A case of lumbar Scheuermann disease, demonstrates end-plates irregularity and Schmorl's nodes with no kyphosis. Scheuermann's disease of the lumbar spine in identical twins. Diagnosis of Scheuermann's disease is based on a physical examincluding observation of postureand analysis of X-rays and any other needed imaging tests. Schmorl nodes are among the diagnostic criteria of Scheuermann disease 6 . Scheuermann's disease is the most common cause of structural kyphosis in adolescence. [ 7 ], who performed a survey study of 67 patients Scheuermanns! Library, NLM provides scheuermann's disease radiology to scientific literature were T11 ( 7.64,. Criteria and population prevalence is that females scheuermann's disease radiology be present which refers to in! Future studies the clinical and radiological features are also crucial agreement with 2008! A review of 32 patients during adolescence period trained technicians at the time the was. Transfeldt EE, Blum RW Scheuermanns kyphosis the diagnosis, whereas Sachs et al ] indicated that with! Scheuermanns patients [ 3,18 ] instrumentation for kyphosis secondary to Scheuermanns disease had a higher risk back... 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