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[Scheuermann disease as predisposition of later spinal disease and its effect on expert assessment in occupational disease examinations].

The Scheuermanns disease is an illness of which the fluoride stage is described as a disorder in growth of the vertebral-intervertebral disk borderline. This stage of the illness ends with the finish of bone growth. Depending on the advanced alterations of the spinal column segments or of the statics of the spinal column up to that point, in later stages of life there will be a higher rate of diskopathies of the lumbar vertebrae and later on of the cervical vertebrae where it often causes arthrosis of the swivel joints. I.e. Morbus Scheuermann is a predisposition for the beginning of diskopathies and has to be added to the differential diagnostic investigation considerations for the examination of causality of the occupation diseases subparagraph 2108 to 2110. We find it justified that the Scheuermanns disease has to be included into the accompanying leaflet as a relevant pre-illness. The thorakal as well as the lumbarthorakal or lumbar manifestation has to be a competitive cause of vocational connection brought under discussion. That is the reason why all the more a preference of the expected segments is required as far as an essential partial cause with a vocational influence with the judgement is discussed. The same also applies to the judgement in a sense of deterioration.

Eligibility Determination↗

Segregation analysis of Scheuermann disease in ninety families from Siberia.

Scheuermann disease [OMIM number 181440] is the most common cause of structural kyphosis in adolescence. Segregation analysis using a model with gender effects was applied to 90 pedigrees from Barnaul (West Siberia, Russia) ascertained through a proband with Scheuermann disease. The transmission probability model was used to detect major gene effect. A significant contribution of a major gene to the control of the pathology was established. Inheritance of the disease can be described within the framework of a dominant major gene diallele model. According to this model, Scheuermann disease should never occur in the absence of the mutant allele. All male carriers of the mutant allele develop the disease, while only a half of female carriers manifest it. We found a high frequency of idiopathic scoliosis in the families with Scheuermann disease (0.08 vs. 0.01-0.02 in general population). We also observed a succession of idiopathic scoliosis and Scheuermann disease in consecutive generations. The familial aggregation of these two spinal pathologies in the present sample may indicate a genetic unity of Scheuermann disease and idiopathic scoliosis.

Adolescent↗

Classical Scheuermann disease in male monozygotic twins: further support for the genetic etiology hypothesis.

STUDY DESIGN: Classic cases of Scheuermann disease in male monozygotic twins are reported. OBJECTIVES: To report classic cases of Scheuermann disease or Scheuermann kyphosis in male monozygotic twins, and to discuss the previous two cases of classic Scheuermann disease in monozygotic twins and the genetic etiology theory of Scheuermann kyphosis. SUMMARY OF BACKGROUND DATA: The etiology of Scheuermann disease remains unclear. Both genetic and mechanical factors or a combination of the two have been postulated to explain Scheuermann disease. The genetic etiology hypothesis has been explained by an autosomal dominant inheritance pattern. In support of this genetic etiology hypothesis, two cases of Scheuermann disease in monozygotic twins have been reported in the English literature. METHODS: The criteria of Sørensen and Sachs et al were used to diagnose Scheuermann kyphosis. Clinical examination and lateral spinal radiographs were performed on a male monozygotic twin. Both parents were clinically investigated for signs of a kyphotic deformity. RESULTS Scheuermann disease was noted in both patients at the same vertebral levels. The Cobb angle of the kyphosis was 74 degrees and 48 degrees, respectively. Clinical examination of both parents did not show any kyphotic abnormality. CONCLUSIONS: These cases of classic Scheuermann disease in monozygotic male twins support the theory that there is a genetic contribution in classic Scheuermann disease.

Adolescent↗

Familial Scheuermann disease: a genetic and linkage study.

Scheuermann juvenile kyphosis or Scheuermann disease is the most frequent cause of kyphosis in adolescence. However, the natural history and genetic basis is still unknown. Reports of identical radiological changes in monozygotic twins, sib recurrence, and transmission over three generations suggest underlying heritability. In this study, 12 probands were referred to us. Upon radiological examination of the proband's parents and sibs, seven were shown to have familial Scheuermann disease with an autosomal dominant pattern of inheritance. Of the remaining five probands, four had chromosomal anomalies. The three largest pedigrees were subjected to linkage analysis with three candidate genes: Duffy, COL1A1, and COL1A2. Linkage of Scheuermann disease was excluded with Duffy (lod score = -2.195 at theta = 0.10) and COL1A2 (lod score = -2.750 at theta = 0.05) in these families.

Adolescent↗

Disc degeneration in Scheuermann disease.

Comparison of the radiographic signs of Scheuermann disease and the corresponding disc degeneration on thoracolumbar magnetic resonance (MR) images was made in 21 young patients. Marginal sclerosis, Schmorl nodes and narrowed disc spaces, but not irregular or wedge-shaped end-plates, were significantly associated with disc degeneration. Fifty-five percent of the discs in the patients with Scheuermann disease were abnormal on MRI, compared with 10% in asymptomatic controls. Our study confirms that thoracolumbar disc degeneration is enhanced in 20-year-old patients with low back pain who have radiological evidence of Scheuermann disease.

Adolescent↗

Vertebral bone density in Scheuermann disease.

The densities of the trabecular bone of two or three lumbar vertebral bodies in twenty adolescents, twelve to eighteen years old, who had Scheuermann disease were measured by quantitative computed tomography. These densities were then compared with those for the same vertebrae of twenty age, sex, and race-matched adolescents who were examined by computed tomography because of trauma. The same scanner and phantom were used in all examinations. Both the adolescents who had Scheuermann disease and the control patients were in good health before the quantitative computed-tomography examination and had not been taking any medications. The density of the trabecular bone density in the patients who had Scheuermann disease was not significantly different (p = 0.28) from that in the controls. There also were no significant differences between the patients and the controls with regard to height, weight, surface area, or body-mass index.

Adolescent↗

Increased Tc-99m MDP in multiple lumbar intervertebral disk spaces in Scheuermann disease without concomitant radiographic calcification or diskitis.

A radionuclide bone scan serendipitously revealed deposition of Tc-99m MDP in multiple lumbar intervertebral disk spaces in a 29-year-old man with extensive trauma to the left femur as a result of a motor vehicle accident. In the authors' experience, alcoholic liver disease or altered weight bearing secondary to prior trauma are not associated with intervertebral radiotracer uptake. Although it is possible that radiographically undetectable microcalcifications in the intervertebral disk spaces associated with degenerative changes, common in Scheuermann disease, account for this unusual finding, a literature search found that increased disk uptake had been reported only in two patients with Scheuermann disease who had concomitant active or healing diskitis. No other causes of increased disk uptake of Tc-99m MDP were found.

Adult↗

Bone scintigraphy in patients with atypical lumbar Scheuermann disease.

Fourteen patients presenting during an 8-year period with radiographic changes suggestive of atypical lumbar Scheuermann disease (ALSD) involving one or more vertebral levels and low-back pain symptoms were referred for bone scintigraphy. Eleven of these studies included single-photon emission computed tomography (SPECT). The bone scans were reviewed with the intent of defining the scintigraphic characteristic of ALSD. Eleven of the 14 patients had subtle increases in activity on planar bone scintigraphy and/or SPECT at the radiographic sites of involvement. These scintigraphic findings should be distinguished from the more intense radiotracer uptake patterns of infection (osteomyelitis and discitis) and trauma (fracture).

Adolescent↗

[Experience in the conservative management of Scheuermann disease].

Authors analyse their 233 cases of Scheuermann's disease, treated 1980 through 1990 and followed in average until the age of 18.5 years. The material is classified according to the radiological appearance. The assessment of the results was based on the decrease of the dorsal kyphosis, the change of the complaints and of the Radiograms. The efficacity of the braces used in various radiological type. The brace, resting on 3 points, is in atypical form ineffective, in classical appearance success may be expected in 30 per cent from its application. In severe cases, or cases treated only late a brace, resting on 3 points is used for the day and a Milwauke brace in the night. Its efficacity could be increased by the physiotherapeutic ceasing of the flexion contracture of the hip and shoulder and of the ischiocrural tension.

Adolescent↗

Scheuermann's disease.

Scheuermann's disease is the most common cause of structural kyphosis in adolescence. The mode of inheritance is likely autosomal dominant and the etiology remains largely unknown. Indications for treatment remain controversial because the true natural history of the disease has not been clearly defined. Brace treatment appears to be very effective if the diagnosis is made early. Surgical treatment is rarely indicated for severe kyphosis (> 75 degrees ) with curve progression, refractory pain, or neurologic deficit.

Adolescent↗

[Evaluation and treatment of Scheuermann's disease].

Scheuermann's disease is considered a kyphoscoliotic process of specific segments of the vertebral column expanding on the original definition of thoracic hyperkyphosis. More important for prognosis than the description of anomalies of single vertebrae is the competent assessment of static imbalance. Because of lacking long-term results no strategies for treatment can be recommended today. Conservative as well as surgical therapies are laborious and their success often rather limited.

Adolescent↗

[Scheuermann's disease].

Scheuermann's disease is most frequently diagnosed in patients between 13 and 17 years and is subdivided into high, long and low kyphoses. The symptoms consist of pain which may be aggravated by physical exertion. Pain is most frequent and most severe in the long and low kyphoses. The etiology and pathogenesis are not entirely elucidated but it is probable that there is a genetic component, that the condition is not unifactorial and that it may be due to weakness in the epiphyseal plates of the vertebrae. Radiography reveals irregularities of the end-plates of the vertebrae, frequently with Schmorl's impressions, narrowing of the intervertebral spaces, one or more wedge-shaped vertebral bodies and increased kyphosing. No effective symptomatic treatment is known but the patients should be advised about choice of career and work. In order to avoid hyperkyphosis and chronic pain, back and abdominal musculature must be strengthened and mobility in the spine improved. Gymnastics, swimming and cycling on stationary bicycles may be recommended but sports associated with jumping and marked stress for the spine must be warned against. In few and severe cases, treatment with a corset or operation may be necessary.

Adolescent↗

[Spastic paraparesis in Scheuermann disease: a case report].

A case of paraparesis due to Scheuermann's disease in a 17.5 years old boy suffering from a moderate dorsal kyphosis (Cobb angle 64 degrees) is reported. Etiologically, spastic paraparesis can be caused either by myelon compression due to extradural cysts, herniated dorsal discs, or direct myelon compression from the vertebral bodies. Radiologically, in addition an intraspinal lipom was suspected. Because of the neurological deficits surgical treatment was performed. Ventral release followed by an anterior spondylodesis was combined with a dorsal spondylodesis using the Harrington compression system. An intraspinal lipom could be excluded intraoperatively after laminectomy of the suspicious region. Three months postoperatively, no signs of any neurological deficits were observable. X-ray control demonstrated a solid spondylodesis with an Cobb angle of 38 degrees. Direct myelon compression or indirect myelon damage due to a reduced blood supply at the apex of kyphosis are supposed to be the pathophysiological pathway.

Adolescent↗

[The development of spinal movements and sagittal curves in postural defects, idiopathic scoliosis and Scheuermann disease (results of longitudinal studies on 5, 10 and 14 year old subjects)].

A given population was followed by authors for 10 years. Children suffering from postural defects, structural scoliosis, spinal osteochondrosis were separated from a normal group. Spinal mobility and posture were compared with the mobility of normal, healthy boys and girls aged 5-14 years. In postural defects physiologically curves could be seen. The range of motion hasn't been physiologic in structural scoliosis. The rotation and flexion of the spine were increased while the lumbar flexion was decreased. Physiologic trend was found in Scheuermann disease, however high values of spinal rotation wasn't found. Extremely increased thoracic kyphosis was found only in children aged 14 years. Perhaps the change of motion is an etiologic factor in structural scoliosis.

Adolescent↗

[Results of operative treatment of Scheuermann disease].

Only rarely is a surgical intervention necessary for increased kyphosis in Scheuermann's disease. However, effective erection of fixed kyphoses is only possible with an incision of the anterior spinal ligament, removal of the discs at the vertex of the curvature, resection of the vertebral arch joints, narrowing of the considerably widened vertebral arches and stabilizing with Harrington's instrumentation. The present authors have treated 11 patients in this way. With this procedure it proved possible to erect the kyphosis on average by 53.4%. In the first postoperative year there was an average loss of correction of 1.7 degrees, though subsequent deterioration was only 0.7 degrees up to the time of the last follow-up examination. The residual correction gain was 50.4 per cent. The results in 4 other patients, in whom Schöllner's erector rods were implanted, were less favorable. The permanent correction was only 50.4 in these cases. The best postoperative results are likely to be obtained by a unilateral ventral and dorsal procedure.

Adolescent↗

[Pott triad and Schmorl nodules. A historical overview of kyphosis with special reference to tuberculous spondylitis and Scheuermann disease].

This report provides an overview of the history of the different types of kyphosis (arcuated and angulated forms). Especially tuberculous spondylitis and Scheuermann's disease are pointed out from among the large group of kyphotic diseases. Therefore, Beckhterew's disease, the combination of rickets and kyphosis as well as the dysraphic diseases and constitutional kyphosis caused by faulty posture are only mentioned. These two special types of kyphosis (Scheuermann's disease and tuberculous spondylitis) are presented from the first description with diagnostic findings, the ideas of pathogenesis and aspects of treatment through to the different periods of medical history. This article describes the way of thinking and discussing of opinion leaders at the beginning of the century and the influence of new techniques and developments (asepsis, antisepsis, anesthesia, bacteriology, X-ray, antibiotics) on the differential diagnosis and therapy. It is impossible to give a complete overview of all aspects during the centuries concerning tuberculous spondylitis or arcuated kyphosis. The authors of this article have focussed their studies on developments from the first descriptions until World War II, based mainly on literature from German journals and historical books from the library of the German Museum for Orthopedic History and Science.

Eponyms↗

The relationship of juvenile lumbar disc disease and Scheuermann's disease.

Between 1969 and 1979 five children were found to have lumbar disc disease and were evaluated for clinically unsuspected thoracic spine abnormalities. Of these five children, two had Scheuermann's disease and one had disc space narrowing associated with Schmorl's nodes. One other had narrowed disc spaces without bony defects, and one had a normal thoracic spine. A unitary concept of childhood lumbar disc disease, Schmorl's nodes and Scheuermann's disease is suggested.

Adolescent↗