Scheuermann's disease

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Overview
Scheuermann’s disease is a self-limiting skeletal disorder of childhood. It is also known as Sherman's Disease (since some people have difficulties spelling Scheuermann) and Scheuermann’s kyphosis, since it results in kyphosis.

Etymology
It is named for Holger Werfel Scheuermann.

It is well characterized for the thoracic spine than for the lumbar spine.

Causes
The cause is not currently known, and the condition appears to be multifactorial. Several candidate genes (such as COL1A2) have been proposed and excluded.

Presentation
Scheuermann's disease is considered a form of juvenile osteochondrosis of the spine. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. Patients suffering with Scheuermann’s kyphosis cannot consciously correct their posture. The apex of their curve, located in the thoracic vertebrae, is quite rigid. The sufferer may feel pain at this apex, which can be aggravated by physical activity and by long periods of standing or sitting; this can have a significantly detrimental effect to their lives as their level of activity is curbed by their condition and they may feel isolated or uneasy amongst their peers if they are children, depending on the level of deformity. Also, the decreased level of height will emphasize body fat around the intestines, making the person with Scheuermann's kyphosis seem more heavy-set than normal. This can make children even more uneasy, with a possibility of being harassed by peers, since they appear to be "fatter" than other children. Whereas in postural kyphosis the vertebrae and disks appear normal, in Scheuermann’s kyphosis they are irregular, often herniated, and wedge shaped over at least three adjacent levels.

The seventh and tenth thoracic vertebrae are most commonly affected. It causes backache and spinal curvature. In very serious cases it may cause internal problems and spinal cord damage. The curvature of the back decreases height, thus putting pressure on internal organs, wearing them out quicker than the natural aging process. A possibility of organ failure increases with long periods of time.

Treatment
There are many ways to treat Scheuermann’s kyphosis. For less extreme cases, manual medicine, physical therapy and/or back braces can help reverse or stop the kyphosis before it does become severe. Severe or extreme cases sometimes may be treated through an extensive surgical procedure. Chiropractic has also been shown to be effective in the treatment of Scheuermann's kyphosis and other scoliotic diseases.

As always, surgical intervention should be used as a last resort once conservative treatment fails or the patient's health is in imminent danger as any surgical procedure is not without risk; however, the chances of complication are relatively low. The surgical procedure partially entails entering two titanium rods, each roughly one and a half feet long, into the back on either side of the spine. Eight titanium screws and hardware are drilled through the bone and secures them in place onto either side of the spine. On the internal-facing side of the spine, ligaments (which can be too short, pulling the spine into the general shape of kyphosis) must be surgically cut or released, not only stopping part of the cause of the kyphosis, but also allowing the titanium rods to pull the spine into a more natural position. Normally, the damaged discs between the troubled vertebrae (wedged vertebrae) are removed and replaced with cartilage from the hip or other parts of the vertebrae, which once healed or 'fused' will solidify. The titanium instrumentation holds everything in place during healing and is not necessary once fusion completes. Recovery begins in the hospital and depending on whether the operation is one or two stage the patient can expect to be in hospital for minimum of a week possibly longer depending on recovery. They will then often be required to wear a brace for several months to ensure the spine heals correctly leaving the patient with the correct posture. The titanium instrumentation can stay in the body permanently, or be removed years later. Patients undergoing surgery for Scheuermann's disease often need physical therapy to manage pain and mobility, patients will struggle with mobility particularly when completing repetitive tasks such as lifting, carrying or exercising this will often last for much or all of their lives.