What Is Scheuermann's Disease?

Scheuermann's disease is a disease that causes structural hump in adolescents.

Hume

Scheuermann's disease is a disease that causes structural hump in adolescents.

TCM disease name

Hume

English name

Scheuermann

English alias

Scheuermann

Multiple groups

teens

Common symptoms

Structural hump

Name

Hume

A stiff spine common to the thoracic or thoracolumbar spine of adolescents was described by Scheuermann (1921) more than 80 years ago

1. The kyphosis is a symmetrical round back deformity. As the disease begins in adolescence, when chest or thoracolumbar kyphosis occurs, family members often think that it is caused by bad posture, which has become a common cause of delay in diagnosis and treatment. Patients may have significant chest and back pain. Aggravated by standing and intense physical activity. After the growth stops, the disease also stops developing, and most of the pain disappears automatically. However, when the deformity is severe, the patient may also have lower back pain at the same time.

2. In addition to the kyphotic deformity of the thoracic segment of the lumbar spine, patients also have varying degrees of (compensatory) lumbar lordosis. For the thoracic segment, the head and neck protrude relatively forward. Excessive lordosis of the lumbar spine is actually the patient's compensation for severe kyphosis of the thoracic spine.

3. Other symptoms (1) Neurological symptoms: Severe kyphosis can cause compression of the spinal cord, and even severe cases may have paresis in the lower limbs. (2) Low back pain: When the disease spreads to the lumbar spine, patients often have lower back pain, which is common in male athletes and mountain populations, indicating that the development and deterioration of the disease are the result of repeated trauma and intense exercise.

4. Complications: Severe kyphosis can cause pulmonary dysfunction.

Non-surgical treatment of Hume

(1) Follow-up observation and science education: Adolescents with kyphosis less than 50 ° should be followed up regularly, including X-rays, until bones mature. During this period, relevant scientific knowledge education should be provided to enable parents and children to understand the disease, pay attention to prevent deformities, and cooperate with treatment.

(2) Functional training: mainly posture training, which has a certain effect on the correction of the disease; the combination of posture training and brace treatment can make the spine flexible, correct excessive lumbar lordosis, and strengthen the spinal extensors. For those with kyphosis less than 75 °, this measure has a positive effect.

(3) Bracing treatment: Bracing treatment can also obtain satisfactory curative effect before bone development is mature, even if the kyphosis is almost 80 °, it is more effective. Because the vertebrae of patients with thoracic vertebrae Scheuermann disease are mostly located at the thorax 8-11, Milkwaukee brace with three-point support can be used. Because of its dynamic three-point correction function, it can increase the thoracic spine's extension and lighten the lumbar lordosis; The thoracolumbar vertebrae type Scheuermann's disease most patients with the parietal vertebrae in the thorax 9 or lower, can use modified axillary thoraco-lumbar-sacral appliance. During brace treatment, postural stretching exercises and hamstring stretching exercises should be performed from beginning to end. Bracing treatment should be continued for at least 2 years after bone maturation. In the last year of brace treatment, you only need to wear the brace at night. Although the deformity of the patient can be significantly corrected after brace treatment, 15% to 30% of the effect may be lost over time.

Surgery surgery

(1) Case selection: Only a small number of patients with Scheuermann's disease need surgery, mainly:

The use of braces in adolescence to control the development of malformations, including those with kyphotic deformities exceeding 80 ° and bones not yet mature. For adults with kyphosis over 75 °, causing persistent dysfunction pain, non-surgical treatments that are ineffective for more than 6 months, and who explicitly request that the appearance be changed to look beautiful can also consider surgery.

(2) Operation: Scheuermann's disease surgery includes correction of kyphosis and spinal fusion. The purpose of correcting kyphosis is to stabilize and balance the spine without causing nerve damage. In addition, attention should also be paid to the presence of structural scoliosis in the spinal deformity segment requiring surgery and the location of the scoliosis. The success rate of pure posterior instrument internal fixation fusion is high, and the risk is less than that of combined anterior and posterior approach surgery, but its curative effect is not good, and the effect of simultaneous anterior and posterior approach is better. Anterior discectomy and anterior longitudinal ligament release + posterior fusion: It is beneficial to the extension of the anterior spine and anterior column support. If the operation is performed in front of the immature bone, vertebral growth can be promoted through anterior ligament release. For mature bones, the anterior column can be prolonged by intervertebral fusion or support (mostly bone graft), and the shortened posterior column can be achieved by posterior spinal fusion. Posterior spinal fusion fixation can increase long-term stability of correction. Pure posterior instrument fusion: The effect is not satisfactory, because this method does not comply with the biomechanical principles of orthopedics. Not only is the correction inadequate, but the rate of false joint formation is also high due to the failure of instrument fixation. The reason for this failure is that this type of fusion and fixation of the posterior column along the tension side prevents the anterior column from sharing the load, which may cause the fusion site to bend, the instrument fixation failure, and the formation of false joints, so it is currently less used. Compound surgery: For those with scoliosis, the operation is more complicated and should be fully designed before operation. ^[1]