Scheuermann's disease is a restricted childhood skeletal disorder. Scheuermann's disease describes a condition in which the spine grows unevenly in relation to the sagittal field; that is, the posterior angle is often greater than the anterior. This uneven growth resulted in the sign of "wedging" the shape of the vertebrae, causing the kyphosis. This is called Holger Scheuermann.
Video Scheuermann's disease
Signs and symptoms
Scheuermann's disease is considered a form of spinal juvenile osteochondrosis. It is found mostly in adolescents and presents a much worse deformity than postural kyphosis. Patients suffering from Scheuermann's kyphosis can not consciously improve their posture. The peak of their curves, located in the thoracic vertebrae, is quite rigid.
Scheuermann's disease is notorious for causing lower back and neck pain and intermediate levels, which can become severe and disabling. Patients may feel pain at the top of the arch, which is exacerbated by physical activity and with a standing or sitting period; this can have a very detrimental effect on their lives because their activity level is curbed by their incompetence. Patients may feel isolated or uncomfortable among their peers if they are children, depending on the degree of deformity.
Besides the pain associated with Scheuermann's disease, many people with disorders have a high vertebral loss, and depending on where the curve peaks, may have a visual 'hunchback' or 'roundback'. It has been reported that the curves in the lower thoracic region cause more pain, while the curves in the upper regions present a more visual deformity. However, it is usually a pain or cosmetic reason that asks the patient to seek help for their condition. In the study, kyphosis was better characterized for thoracic spine than for lumbar spine.
The seventh and tenth thoracic bone is most commonly affected. It causes back pain and curvature of the spine. In very serious cases it can cause internal problems and spinal cord damage, but the case is very rare. The back curvature lowers the height, thus putting pressure on the internal organs, wearing it faster than the natural aging process; Surgical procedures are almost always recommended in this case.
Related conditions
Many with Scheuermann's disease often have excessive lordotic curves in the lumbar spine; this is the body's natural way to compensate for the above kyphotic curve. Interestingly, many with Scheuermann's disease have very large lung capacity and men often have broad breasts, chests. Most people have imposed a value of vital capacity (FVC) above average. It has been proposed that this is the body's natural way to compensate for the loss of depth of breathing.
Often patients have tight hamstrings, which, again, are related to the body that compensates for excessive spinal curvature, although this is also disputed (eg, some suggest ligamentous tightness is the initial cause of growth abnormalities). In addition to general lordosis, it has been suggested that between 20-30% of patients with Scheuermann's Disease also have scoliosis, although most cases are meaningless. However, in more serious cases, this combination is classified as a separate condition known as kyphoscoliosis.
Maps Scheuermann's disease
Cause
The cause is currently unknown, and the condition seems multifactorial. Several candidate genes (such as FBN1, which have been linked to Marfan) have been proposed and excluded.
Diagnosis
Diagnosis is usually done with medical imaging. The kyphosis rate can be measured by Cobb angle and sagittal balance.
Treatment
Conservative
Scheuermann's disease is self-limiting after growth is complete, which means that it generally runs on its own and never leads to further complications. Usually, however, once the patient is fully grown, the bone will maintain the deformity. For this reason, there are many treatment methods and options available that aim to improve kyphosis while the spine is still growing, and primarily aims to prevent it from worsening.
Although there is no explanation for what causes Scheuermann's disease, there is a way to treat it. For decades there has been a lot of controversy surrounding treatment options. For less extreme cases, manual medication, physical therapy and/or back support may help to reverse or stop kyphosis before it becomes severe. Because the disease is often benign, and because back surgery contains many risks, surgery is usually considered a last resort for patients. In severe or extreme cases, patients can be treated through extensive surgical procedures in an attempt to prevent the disease from worsening or harming the body.
In Germany, standard treatment for both Scheuermann's disease and lumbar kyphosis is the Schroth method, a specialized physical therapy system for scoliosis and associated spine deformity. This method has been shown to reduce pain and decrease kyphotic angle significantly during inpatient care programs.
Surgery
Scheuermann's disease can be successfully corrected by surgical procedures, almost all of which include spinal fusion and hardware instrumentation, ie rods, pedicle screws, etc. While many patients are usually attracted to get surgery for their correction, it is important to be aware of operations aimed at reducing pain, and not a cosmetic defect. As always, surgical intervention should be used as a last resort after conservative treatment fails or the patient's health is in danger because any surgical procedure is not without risk; however, the likelihood of complications is relatively low and surgery is often successful.
One of the biggest debates surrounding the correction of Scheuermann's disease is the use of very different corrective procedures. There are several different techniques to improve kyphosis; usually the difference becomes posterior/anterior entry or posterior entry (back) only. The classical surgical procedure partly requires inserting two titanium rods, each approximately one and a half feet long (depending on the size of khyphosis), backward on both sides of the spine. Eight titanium screws and hardware are drilled through the bone and secure the rods to both sides of the spine. On the side of the spine that faces inward, the ligaments (which can be too short, pull the spine into the general form of kyphosis) should be cut or released surgically, not only stopping part of the cause of kyphosis, but also allowing the titanium rod to pull the spine into a more natural position. Usually, damaged discs between troubled vertebrae (pinched vertebrae) are removed and replaced with bone transplants from the hip or other parts of the vertebra, which, once healed or 'fused' will solidify. Titanium instrumentation retains everything during healing and is not needed once the fusion is complete. Recovery begins in the hospital and depending on whether surgery is one or two stages patients can expect to be in hospital for at least a week, may take longer depending on recovery. They will then often be asked to wear a brace for several months to ensure the spine heals properly leaving the patient with the correct posture. Titanium instrumentation can stay in the body permanently, or be removed a few years later. Patients undergoing surgery for Scheuermann's disease often require physical therapy to manage pain and mobility, but their range of motion is generally unlimited. Recovery from kyphosis correction surgery can be very long; usually patients are not allowed to lift anything above 5 or 10 pounds for 6 months to a year. Many do not work for at least 6 months. However, once the fusion is solidified, most patients can return to their usual lifestyle in one to two years.
Prognosis
Spinal fusion for kyphosis and scoliosis is a highly invasive surgery. The risk of complications is estimated at about 10%. Possible complications are inflammation of the soft tissues or deep inflammatory processes, respiratory problems, bleeding and nerve injury, or infection. As early as five years after surgery about 5% require repeat surgery and long-term problems remain unclear. Taking into consideration that some symptoms of spinal deformity can not be altered by surgical intervention, surgery remains a cosmetic indication, although the cosmetic effects of surgery are not always stable.
Famous cases
- Milan Lucic, NHL hockey player for Edmonton Oilers
- Hunter Pence, professional baseball player for the San Francisco Giants
- George Sampson, winner of the second series of Britain's Got Talent
- Marcel Dettmann, the leading German techno DJ
- Angus Gardner, Australian Rugby Union referee
References
External links
- https://web.archive.org/web/20061011043802/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): Non-Normal Spinal Curvature
- https://web.archive.org/web/20061018060205/http://www.allaboutbackandneckpain.com/html/spinesub.asp?id=27
Source of the article : Wikipedia
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