Scheuermann’s disease

This growth disorder is the most common spinal disorder in adolescents. If the appropriate therapy is not started in time, a fixed “hunchback” can develop. Everything about the causes, the first symptoms, what you can do for your child against Scheuermann’s, as it is colloquially known, and how the doctor treats it.

What is Scheuermann's disease?

Scheuermann’s disease, a growth disorder, is hardly noticeable in children and adolescents at first. To a certain extent, it is quite normal for the spine to curve slightly forward towards the neck. However, if this leads to changes in the spine, there is a risk that this curvature, known medically as kyphosis, will become more pronounced. Because young people are still growing. This ossification disorder can become established and permanently change the spine: A so-called hunchback develops. Depending on how severe it is, it can lead to various problems, not just pain.

This spinal disorder usually begins between the ages of eleven and 13. Noticeably more boys are affected than girls. Scheuermann’s disease was named after the Danish orthopaedic surgeon and radiologist Holger W. Scheuermann (1877-1960), who published the first scientific paper on this disease in 1921 (Kyphosis dorsalis juvenilis).

Because the severe curvature, i.e. the excessive kyphosis, develops and becomes apparent during growth, experts also refer to this growth disorder of the spine as juvenile kyphosis (juvenile for youthful) or adolescent kyphosis (adolescence for adolescents, i.e. the phase between puberty and adulthood).

The term Scheuermann’s disease refers to a growth disorder of the spine associated with severe curvature and the formation of a rounded back, formerly known as a tailor’s hump. To better understand the disease, it is important to know the anatomy of the spine. This perhaps most important support structure of the body is comparable to small cube-shaped cuboids placed on top of each other, the vertebral bodies. The intervertebral discs act as a buffer in the gaps between the vertebrae. In order to be elastic and resilient, the spine is not statically straight, but is structured in a double S-curve, with an arc visible from the side between the lumbar vertebrae and sacrum and between the cervical and thoracic spine.

During growth, the spine also becomes longer and all its structures and tissues grow evenly. This can lead to growth disorders, as in Scheuermann’s disease. In the thoracic spine, the cartilaginous base and upper plates of the vertebral bodies do not grow evenly in their anterior and posterior regions. In the front part, which points towards the chest (ventral), they grow more slowly than in their rear area (dorsal). The vertebral bodies, which are actually cube-shaped, gradually take on the shape of a wedge. So-called wedge vortices are formed. This causes the spine to curve forward more than normal, resulting in a hunched back.

Sometimes Scheuermann’s disease does not affect the thoracic spine, but the lumbar spine. The natural forward curvature of the spine in this section decreases, the curve becomes flatter and a flat back forms. However, this version of Scheuermann’s disease is much rarer than localization in the thoracic spine with a hunchback.

Scheuermann's disease: causes and risk factors

The actual reasons why some children and adolescents develop wedge vertebrae and others do not are not yet fully understood. The exact triggers have therefore not been proven. Several factors are probably responsible for the development of Scheuermann’s disease, which may also reinforce each other. A hereditary component is obvious. This is because there are families in which this growth disorder occurs more frequently.

Risk factors also come into play:

• One-sided strain on the spine and one-sided overloading – such as sitting for long periods with the neck stretched forward – typical, but incorrect, posture in front of the computer or gaming console. In the past, the crouching posture of apprentice tailors led to corresponding changes, hence the name tailor’s hump, but these changes can also occur in some high-performance sports.
• Poor posture with sagging upper body – “bad posture” with sunken chest, lowered shoulders, chin pointing downwards
• Generally weak back and abdominal muscles

Symptoms: barely present to severe - depending on the stage of Scheuermann's disease

The signs and symptoms of Scheuermann’s disease can be divided into three stages:

• Initially, the symptoms are barely noticeable, so the disease begins unnoticed. Only very rarely can pain become noticeable. This is because the vertebral changes must have reached a certain level in order to have an effect. At this early stage, Scheuermann’s disease is therefore rarely discovered, and when it is, it is an incidental finding.
• If the disease progresses, the doctor refers to this as the active or florid stage. The clear symptoms: a hunched back develops, the arms fall slightly forward and the chest sinks in. Back pain occurs.
• In the third stage, the final stage, the growth disorder has not only led to a hunched back and massive pain, but the deformity changes the statics of the entire body and already has further, indirect consequences in other joints. This also leads to incorrect strain on the ligaments, tendons and muscles. Intervertebral discs in other areas of the spine are also affected, such as those in the lumbar vertebrae.

The following are also possible:

• Breathing problems, but only with severe Scheuermann’s disease
• neurological changes such as discomfort caused by the altered statics, which can also lead to pressure on the nerves or the spinal cord.

Last but not least, the disease leads to severe psychological stress in adolescents. At this age in particular, when people are exploring their own identity and appearance and the group community are considered important, the external impression is often overrated.

Scheuermann’s disease: Diagnosis with us

The first port of call is the pediatrician. As part of the interdisciplinary spine center at the USZ, the Clinic for Rheumatology is a competent point of contact for young people aged 16 and over. The examination begins with an anamnesis, i.e. questions about medical history, pain and abnormalities. We also ask whether there is a family history of spinal diseases or growth disorders.

This is followed by a physical examination with palpation of the spine and simple tests to check the mobility of the spine, identify any restrictions and recognize neurological symptoms.

Imaging examinations such as X-rays then provide precise information. If Scheuermann’s disease is present, we will be able to identify typical changes on the images:

• Wedge swivel
• Altered base and top plates of the vertebral bodies
• Schmorl’s nodules or Schmorl’s nodules – these changes in the vertebral body plates can cause disc tissue to penetrate into the vertebral bodies, forming the typical small nodules.

We can also use the images to determine the so-called Cobb angle. It is used to measure the curvature of the spine, i.e. describes the angle formed by the vertebral bodies.

Magnetic resonance imaging (MRI) is also sometimes used, which can often detect Scheuermann’s disease at an early stage.

The Trauma Clinic offers a special X-ray-free examination procedure for monitoring the progression of deformities as part of the interdisciplinary Spine Center. With the DIERS 4D Motion® Lab, the shape of the spine can be checked while standing and in gait analysis; and all without X-rays.

Scheuermann's disease: prevention, early detection, prognosis

There is a lot you can do together with your child to minimize the risk of this growth disorder. Top priority: Encourage an upright posture, while also setting a good example. However, it is always important that it is fun for the child and does not lead to stress and pressure. These measures support a healthy posture:

• Take your child swimming once a week or, if your child loves swimming, enrol them in a swimming club.
• Make sure that your child gets plenty of exercise in general. Perhaps he enjoys group sports, such as football, handball, floorball or more dance gymnastics.
• Please avoid your child sitting in front of the computer or gaming console for hours on end and adopting a poor posture. It is also unfavorable to play on a tablet or cell phone for long periods with a tilted head and poor posture.
• Make sure your child has a good ergonomic desk chair and desk.

Also pay attention to whether your child is already developing a hunched back. It is often not easy to tell whether it is still a natural, slight curvature of the upper back or whether it is already Scheuermann’s disease in the early stages.

The slip test provides information here:

The child kneels on the floor and slides forward with their hands as far as possible. At the end, the arms and spine should form a straight line. That would be ideal. If there is no line, but the upper back cannot be stretched completely straight, it may already be a hunchback. Then please seek medical advice as soon as possible to have this clarified.

Progression and prognosis of Scheuermann’s disease

The prognosis for this growth disorder is generally very positive if treatment is started as early as possible. But even if treatment is not carried out until later, in young adults, the chances of success are usually still good.

The chances of permanent freedom from symptoms are only somewhat lower if the spine is particularly severely curved or if scoliosis has also occurred. Then the spine bent sideways, twisting the individual vertebral bodies.

Scheuermann's disease: treatment mainly involves gymnastics, rarely surgery

Depending on the severity of Scheuermann’s disease and the age of the person affected, various measures and methods are possible. The main focus of treatment is always to prevent the progression of Scheuermann’s disease so that the back does not become even more curved and to straighten the hunchback as far as possible.

The earlier the treatment begins and the younger the affected person is – the growth phase should ideally not yet be completed – the more successful the therapy will be: in the vast majority of cases, conservative treatment, i.e. gymnastic exercises as part of physiotherapy, is sufficient. This specifically strengthens muscle groups that straighten the back and make it flexible. Important: It is not enough to do the exercises only with the physiotherapist; you should also exercise at home as often as possible according to instructions.

If the curvature is more pronounced and exercises alone are not enough, the doctor may prescribe a special corset. This support corset is made individually and is tailor-made, so to speak. Initially, it has to be worn almost all day and night, later only on an hourly basis. As the child grows, the fit of the corset must be checked regularly and the corset adjusted accordingly.

If the affected person is already older and the hunchback is pronounced, surgery is also an additional treatment option for Scheuermann’s disease. The surgeon uses screws and metal plates to straighten the spine.