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Adolescents often complain about back pain, but knowing the actual cause of the condition is important. It is known as Scheuermann’s disease. Let’s know about the causes, treatments, and more of the disease.
New Delhi:
In adolescents, extreme thoracic kyphosis is most often secondary to Scheuermann’s disease. With an incidence of 1–8%, tumours are nearly equally distributed between boys and girls. This entity was first reported in 1921 by Danish physician and radiologist Holger Werfel Scheuermann, when he described 105 children with a painful, roundback deformity.
According to Dr Kasinath Swain, consultant—orthopaedics and spine surgery, Manipal Hospital, Bhubaneswar, Scheuermann’s occurs most often during the growth spurt that occurs in early adolescence and is usually diagnosed when a child is between 10 and 12. The clinical presentation of this disease can be disconcerting, impacting one’s lifestyle and causing substantial pain to the back, psychological anguish, altered appearance, and social awkwardness. In a few cases, it can even progress to cardiorespiratory failure. Nevertheless, the prognosis is more favourable when the deformity is in the thoracic spine than when it is in the thoracolumbar area.
Though the exact cause of Scheuermann’s disease is unknown, there are many proposed factors. That have been associated with back pain among them are abnormalities in vertebral endplates, the impact of upright posture, juvenile osteoporosis, increasing growth hormone, defects in collagen formation, trauma, and vitamin A deficiency. Several aetiologic factors, such as epiphysitis, poliomyelitis, osteochondrosis, prolonged sitting, avascular necrosis of the vertebral ring apophysis, and genetic predisposition, have also been suggested.
Diagnosis and No Operative Treatment
The diagnosis is based on clinical examination of the kyphotic deformity in combination with imaging. Standard X-rays in posterior-anterior and lateral views are imperative. In some cases, additional imaging, such as CT scans and MRI, is necessary for more detailed evaluation and treatment planning.
The treatment approach is conservative for most cases, which includes observation, conditioning programs, physical therapy, bracing, and NSAIDs. Adolescent patients with kyphosis less than 60 degrees should be monitored every 6 months with radiographs.
The Milwaukee brace is believed to be the best orthotic intervention, but if the deformity is rigid, casting may be more advantageous. Patients are recommended to wear the brace for a minimum of 16 hours per day. Physical therapy can be started concurrently with trunk stabilisation and postural re-education and pec and hamstring stretching.
For skeletally immature patients with flexible deformities, a protocol to bear weight was undertaken in the 6S program. This protocol consists of six weeks of hyperextension Risser casting, six months of Milwaukee brace wear, and six weeks of schooling. Compliance and success rates are reported to be superior with the regimented schedule, especially in adolescent patients. Long-term follow-up is suggested until the patient is skeletally mature. Parents need to be educated that the brace will not preserve 100% of the correction after brace weaning.
Indications for Surgery and Current Correction Modalities
Surgery is indicated when thoracic kyphosis exceeds 75 degrees in skeletally immature patients and is symptomatic or when thoracolumbar kyphosis is greater than 50 to 55 degrees and non-responsive to conservative measures. It might also be performed if the deformity increases despite bracing or in the event a patient, family, or surgeon deems the cosmetic result unacceptable.
The current gold standard in surgical treatment is the posterior approach with transpedicular screw fixation. They should be corrected to a kyphotic angle at the [high-normal value: 40–50°], as overcorrection may cause neurological deficit. The judicious use of the number of fusion levels and focusing on spino-pelvic alignment form the basis for good results in this deformity. IOM plays a critical role in safeguarding patients’ safety during the correction process.
Disclaimer: (Tips and suggestions mentioned in the article are for general information only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.)
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