Juvenile Osteochondrosis Of The Spine

What Causes Juvenile Osteochondrosis Of The Spine?

Osteochondrosis is a self-limiting developmental derangement of normal bone growth. Scheuermann’s disease is considered to be a form of juvenile osteochondrosis of the spine. Normally, vertebrae are more or less cylindrical in shape. However with Scheuermann’s disease parts of the vertebrae to grow at different rates during a child’s growth spurt. Resulting in some of the vertebrae becoming wedge-shaped. The end product of which, is an exaggerated forward curvature of the upper back. Scheuermann’s disease cause is unknown. However, it has a familial tendency and there are multiple factors that appear to play a role in the development of juvenile osteochondrosis of the spine. Including:

• Infection
• Juvenile osteoporosis
• Malabsorption
• Endocrine disorders
• Biomechanical factors (such as a shortened sternum)

Diagnosing Scheuermann’s Disease

Often diagnosis is sought as a result of cosmetic concerns regarding the “hump” appearance of the upper back, rather than being due to pain. Frequently there is a delay in diagnosis, as it is commonly suspected that the child has a postural kyphosis that is correctable. And is related to weak muscles, and not the structural kyphosis that is Scheuermann’s disease.

• An MRI can show more detail if necessary. However generally a diagnosis is reached via physical examination. Including the observation of posture combined with viewing simple X-Ray films.
• On X-Ray they are looking for signs of the classical wedge shaping of the thoracic vertebrae. And the presence of Schmorl’s Nodes (protrusions of the intervertebral disc through the vertebral body endplate, projecting into the adjacent vertebra.

From a measurement point of view, on X-ray juvenile osteochondrosis of the spine causing Scheuermann’s disease is usually the agreed diagnosis if:

• There is a thoracic curvature of 45 deg, or more.
• Three or more adjacent vertebrae are wedged by at least 5deg per segment.

Treatment Of Juvenile Osteochondrosis Of The Spine

A variety of factors will help determine the best treatment approach for Scheuermann’s disease. Namely patient preferences and other factors for consideration include:

• The severity of the curvature. The human spine is designed to curve. However, if the curvature reaches 45 degrees, or greater it is considered abnormal. Allowing abnormal curvature to continue to develop over time may cause pain and cosmetic disfigurement with the associated negative impacts associated with this.
• The amount of spinal flexibility. Typically with osteochondrosis of the spine there is significant movement restriction in the affected area. The severity of movement and functional restriction may indicate a necessity for treatment.
• If an individual is expected to continue growing. With the presence of a slight curvature in a young person who is still growing, and shows no sign of the curvature worsening. And only mild, or no symptoms of pain, may not require formal intervention. In this situation the individual may be monitored by their doctor. Undergoing periodic assessment, and or X-rays to keep “tabs” on curvature, functional and symptom changes.
• The individuals concerns regarding their appearance as a result of the increased spinal curvature. This is often a strong driver to seeking medical opinion and considering treatment options. 

Treatment Options

Bracing is for individuals who are still growing and have more advanced curvature. Bracing for individuals who are no longer growing is seldom used as a treatment option. The goal of the brace is to halt (ideally reverse) any additional curvature progression during developmental years. The use of postural bracing can have the added benefit of reducing pain in symptomatic patients.
In conjunction with, or independent of bracing, physiotherapy and an exercise program is often recommended. While exercise won’t actually correct any deformity, exercise can be beneficial in maintaining flexibility, as well as alleviating back pain.

Surgical Options

Surgery is rarely employed as a treatment option with Scheuermann’s disease except in the most advanced cases. Non-surgical options will typically always be exhausted prior to surgery being considered.

• Surgery may be suggested if there is a thoracic kyphosis curvature of more than 75 degrees.
• If neurological deficits are present.
• And occasionally if significant pain is caused by the deformity.

The goal of the surgery is namely to reduce the deformity, and possibly lessen pain, or neurological symptoms.

Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Juvenile Osteochondrosis Of The Spine should consult his or her physiotherapist, general practitioner or otherwise appropriately skilled practitioner.