IS Case 242: Scheuermann disease

Jerry Lee, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-26

History

Patient is a 19-year-old male status post-motor vehicle collision (MVC).

Findings

AP and lateral projections of the thoracic spine demonstrate multiple levels of anterior vertebral body wedging, irregularity of the vertebral body endplates, and multiple Schmorl nodes. No acute fracture or dislocation.

Discussion

Scheuermann disease or juvenile kyphosis is considered a form of juvenile osteochondrosis of the spine, mostly found in teenagers and presents a significantly worse deformity than postural kyphosis. The definition of Scheuermann disease includes: anterior wedging of 3 or more adjacent thoracic vertebral bodies (greater than 4 degrees) leading to kyphosis, multiple Schmorl nodes, and endplate narrowing and undulation secondary to extensive disc invagination. Schmorl nodes without anterior wedging is not indicative of Scheuermann disease. Other radiographic findings include limbus vertebrae, disc space narrowing, and scoliosis.

Peak incidence is from 13 to 17 years, usually developing during adolescence and may present later in life. Etiologies include chronic repetitive trauma such as weight lifting, gymnastics, hard labor or other spine loading activities. Disc extrusions occur though weakened regions of vertebral end plates leading to disc space loss, Schmorl nodes, and limbus vertebrae. Delayed growth in the anterior portion of the vertebral bodes causes wedging.

References

  1. Greenspan A. Orthopedic Imaging: A Practical Approach. 4th ed., Philadelphia: Lippincott Williams & Wilkins, 2004.

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