Scheuermann's disease: current diagnosis and treatment approach.

OBJECTIVES: To summarize the current knowledge relating to diagnosing and treating Scheuermann's disease. Scheuermann's disease is the most common cause of structural kyphosis in adolescence. METHODS: A literature-based narrative review of English language medical literature. RESULTS AND CONCLUSIONS: Recent studies have revealed a major genetic contribution (a dominant autosomal inheritance pattern with high penetrance and variable expressivity) to the etiology of Scheuermann kyphosis with a smaller environmental component (most probably mechanical factors). The natural history of Scheuermann kyphosis remains controversial, with conflicting reports as to the severity of pain and physical disability. Since we cannot predict which kyphotic curves will progress, we are unable to determine effectiveness of brace treatment. Physical therapy is scarcely mentioned in the literature as an effective treatment for Scheuermann kyphosis. Although there is little evidence that physical therapy alone can alter the natural history of Scheuermann's disease, it is often used as the first choice of treatment. Brace treatment appears to be more effective if an early diagnosis is made, prior to the curvature angle exceeding 50° in patients continuing to grow. Surgical treatment is rarely indicated for severe kyphosis (>75°) with curve progression, refractory pain, or a neurologic deficit. Rigorous methodology clinical trials are essential to evaluate the efficacy of conservative interventions, especially different exercises and manual therapies and their combinations with braces.

Dorso curvo / Curve dorse

El dorso curvo es una patología frecuente en la infancia y adolescencia, por lo tanto, el pediatra puede verse enfrentado en numerosas oportunidades con el problema. Tanto los padres como los médicos pueden notar la anormalidad y asumir que se trata sólo de un problema postural, restándole la importancia que se merece. La experiencia demuestra que frecuentemente lo que se encuentra bajo este aparente problema postural es una alteración estructural de la columna vertebral, cuyo reconocimiento y tratamientoprecoz permite llegar a resultados satisfactorios sobre la deformidad y sobre las consecuencias uque esta anomalía podría provocar de ser abandonada a su suerte

[Diagnosis of vertebral diseases by vertebral biopsy]. / Diagnostik von Wirbelsäulenerkrankungen durch Wirbelpunktion.

Vertebral biopsies were performed in 28 patients, 17 males and 11 females, because of vertebral body and disc changes between June 1978 and May 1982. In two patients biopsy was performed in two segments. Punctures were done in local and superficial anaesthesia of the vertebral body periosteum during continuous fluoroscopy control using Jamshidi's instrumentation. Aspiration and tissue cylinders were evaluated histologically and bacteriologically. There were no complications among the 8 thoracic and 22 lumbar biopsies. A histologic diagnosis could be established in 22 cases (78.6%): plasmocytoma (n = 2), spontaneous deformation of the spine in osteoporosis (n = 3), Scheuermann's disease (n = 1), specific (n = 2) and nonspecific (n = 14) spondylitis. Demonstration of bacteria was possible in 5 out of the 16 cases of spondylitis (31.25%): in two cases tubercle bacilli were demonstrated and once each salmonella group B, Haemophilus aphrophilus and coagulase-negative staphylococci. Only in 6 cases a diagnosis could not be established from the biopsy material.