Scheuermann's Disease – Symptoms, Diagnosis, and Treatment of Scheuermann's Disease

Proper posture is defined as shoulders pulled back and a straight back. In Scheuermann’s disease, however, a pronounced rounded back (hump) is evident. It results from a change in the shape of the vertebral bodies and a spine that is curved backward.

Other terms for Scheuermann’s disease include

• adolescent kyphosis,
• Scheuermann’s disease,
• juvenile kyphosis, and
• juvenile osteochondrosis.

Colloquially, it is also referred to as a hump or “apprentice’s back.”

With a prevalence of about 20 percent, Scheuermann’s disease is one of the most common conditions in adolescence. In the general population, about 4 to 6 percent of people are affected. Males are affected at least twice as often as females.

In its normal, healthy state, the human spine has a double curvature:

• The thoracic spine curves backward by 20 to 40 degrees (medically known as kyphosis),
• and the lumbar spine is slightly curved forward (lordosis).

If the angle of kyphosis exceeds 40 degrees, the condition is referred to as Scheuermann’s disease. Severe kyphosis is defined as an angle of more than 70 degrees.

Starting around age 11, the condition can be diagnosed based on clinical findings and radiologically visible changes. By the end of pubertal growth, the pathological changes in the vertebral bodies have stabilized, but the physical changes remain. In most adolescents, the condition is diagnosed between the ages of 11 and 17.

Normally, the vertebral bodies are cylindrical in shape. In Scheuermann’s disease, however, a growth disorder causes the vertebrae to grow more slowly on the front side than on the back. As a result, the vertebrae develop a wedge-like shape (wedge-shaped vertebrae). 

In most cases, the vertebrae of the middle and lower thoracic spine are affected. Less commonly, the condition also affects the lumbar vertebrae or the vertebrae in the transition zone between the thoracic and lumbar spine.

Another characteristic feature of Scheuermann’s disease is the presence of so-called Schmorl’s nodes. These are disc tissue that has herniated into the bone substance of the vertebral bodies and endplates.

Researchers suspect a genetic predisposition underlies the abnormal growth of the vertebrae. However, the exact cause of the condition is still the subject of scientific research.

One frequently discussed theory is that the disorder stems from disturbances in mineralization and ossification processes during the pubertal growth phase. Consequently, conditions such as childhood osteoporosis or an excess of growth hormones are also suspected causes.

In addition, there are external factors that may contribute to the development of Scheuermann’s disease. These include, for example,

• competitive sports that place strain on the back,
• sports that require a rounded back (e.g., rowing or weightlifting),
• a generally stooped posture.

In addition, there are external factors that may contribute to the development of Scheuermann’s disease. These include

• competitive sports that place strain on the back,
• sports that require a rounded back (e.g., rowing or weightlifting),
• a generally stooped posture.

In the early stages, Scheuermann’s disease often causes no problems or pain at all. If the thoracic spine is affected, a clearly visible curvature develops.

In the thoracic spine, the condition manifests as a rounded back. In the lumbar spine, however, the back is straight, not curved forward as is typical (flat back).

Back pain, however, often does not occur until the disease has progressed further. It may worsen during physical activity and improve at rest. The pain usually subsides once growth is complete.

The clinical symptoms as the condition progresses and in adults depend largely on the degree of curvature. Under certain circumstances, this can lead to

• restricted movement,
• ossification of the affected segments of the spine,
• increasing lordosis (forward curvature) of the adjacent segments,
• in rare cases, neurological deficits due to spinal cord compression (pressure on the spinal cord),
• and, in cases of extreme kyphosis (curvature angle greater than 100 degrees), to impaired heart and lung function

may occur.

Furthermore, the rounded back may worsen over time. This condition is called post-Scheuermann syndrome. The back muscles are under extreme strain in Scheuermann’s disease and are thus constantly overloaded. This can lead to pain. People with a hunched back have an increased risk of chronic back pain compared to the general population.

The following symptoms and long-term complications may therefore occur with Scheuermann’s disease:

• Hunchback or flat back (sometimes painless in the early stages)
• Chronic back pain
• Limited range of motion
• Neurological deficits due to spinal cord compression
• Progression of the hump (post-Scheuermann syndrome)

In most cases, young patients seek medical attention due to the developing rounded back and/or back pain.

The doctor asks the patient about

• the nature of the pain,
• functional limitations,
• neurological symptoms, and
• other complaints.

The specialist then assesses, as part of a physical examination,

• the shape of the spine,
• the severity of the deformity,
• the triggering of pain,
• neurological and other physical abnormalities.

An X-ray of the thoracic and lumbar spine provides definitive confirmation of whether excessive kyphosis is present. X-rays can also identify the typical wedge-shaped vertebral bodies and Schmorl’s nodes.

Magnetic resonance imaging (MRI) or computed tomography (CT) is required only in very rare cases. Specific laboratory tests or histological examinations are generally not necessary for diagnosis.

During the growth phase, adolescents should have their spinal deformity monitored at regular intervals. This allows doctors to determine whether the spinal deformity is worsening. Once growth is complete, follow-up examinations are no longer necessary, provided there are no symptoms.

Whether treatment is necessary depends largely on whether

• pain is present,
• the degree of curvature is increasing, and
• there are neurological deficits.

The goal of treatment is to

• prevent a fixed kyphosis with limited mobility,
• to prevent the progression to a severe spinal deformity,
• to reduce or eliminate pain, and
• correct the spinal deformity.

There are generally several therapeutic options available. Depending on the symptoms and the angle of the curvature, they are used individually or in combination:

• lifestyle changes,
• muscle strengthening and physical therapy,
• medication,
• Wearing a corrective brace or orthosis, and
• surgical treatment.

In terms of lifestyle changes, for example, sleeping on your stomach on a firmer mattress is recommended. You should also avoid sports that compress the spine (such as jumping sports) or require a hunched posture. In addition, do not sit in a hunched position for long periods of time, and do not subject the spine to improper strain.

Physical therapy plays a central role in treatment. The therapist can significantly improve posture through special exercises designed to strengthen the muscles. The goal is to straighten the curved spine. In mild cases of the condition, physical therapy alone may be sufficient to achieve success.

Exercises alone do not always produce the desired results. In such cases, the patient may also wear a corset or orthosis. These devices help straighten the spine.

Wearing a corset is particularly effective during the growth phase. However, corset therapy can only be successful if the patient wears the corset for as much of the day as possible. This therefore requires a great deal of self-discipline.

Medication involves the use of pain relievers and muscle relaxants.

Surgical Treatment for Scheuermann’s Disease

Surgery for Scheuermann’s disease carries significant risks. Possible complications of the surgery include

• stiffening of the affected section of the spine,
• nerve damage, or even
• a spinal cord injury.

Therefore, the decision to perform surgery should only be made after careful consideration of the benefits and risks. Indications are extremely rare cases, namely

• a curvature angle greater than 75 degrees with a deformity that the patient can no longer tolerate or that is accompanied by pain,
• in cases of neurological deficits or spinal cord compression, or
• in cases of pain that cannot be treated by other means.

During the surgery

• the surgeon replaces the intervertebral discs with bone segments,
• removes parts of the vertebral bodies, and
• inserts metal implants.

Generally, the prognosis for Scheuermann’s disease is very good, as the condition does not necessarily cause pain. The course of the disease can also be positively influenced through physical therapy or a brace.

However, depending on the extent of the spinal deformity, complications may arise even in later adulthood. Symptoms such as pain or limited mobility are to be expected if scoliosis is present in addition to kyphosis or if an extremely flat back develops.