Etiology of Scheuermann disease and the effect of brace and orthopaedic surgeries in controlling its process

Abstract

Objective: Scheuermann disease is a progressive thoracic or thoracolumbar kyphotic deformity of spine, which is the most common cause of structural kyphosis in adolescents. Braces have been applied in the treatment of such deformed immature skeletons of patients, through there are lack of definite results to verify that braces can be employed to treat deformities of Scheuermann disease effectively so far. The etiology is still incompletely unknown, although the episode of Scheuermann disease is related to genetics. The cause of Scheuermann disease is probably multifarious. So, it is necessary to comprehend the etiology and treatment of Scheuermann disease further. Data sources: A computer-based search of Medline for the articles about etiology and treatment of Scheuermann disease published between 1980 and 2003 was performed by using the key word "Scheuermann disease, and the language was limited to English". Study selection: After the articles were primarily checked up, some case reports were screened out, and retrospective clinical articles were looked up for the full texts. Data extraction: Totally 41 retrospective clinical studies on Scheuermann disease were collected, in which 33 were accordant with inclusion criteria, and 8 were excluded because they were simple case reports or reviews. Data synthesis: In the 33 articles, over 1100 clinical studies and experiments were performed on the etiology, pathology, natural history, diagnosis and treatment of Scheuermann disease. Operation manners included conservative treatment and surgical treatment. The braces for Scheuermann disease is most satisfactory to those with 45° to 65° thoracic kyphosis, but to those with conservative management- more than 75° kyphosis or those with conservative management-uncontrollable pain, they should be treated by operation after they were told to weigh the potential risk of operation and expected outcomes of nonoperative treatment. Kyphotic deformity-induced changes of physiological function mainly resulted from some physiologic activities of viscera in thoracic cavity and abdominal cavity compressed and limited by flexion deformity of spine. Physiological status of curvature of cervical vertebra, hip joint and knee joint could be improved or recovered by orthopaedic surgeries. Conclusion: Osteochondritis and epiphysitis result in Scheuermann disease nonspecifically. Lateral curvature possesses high incidence in the family members of Scheuermann disease, and is hereditary during successive passage. Kyphosis of Scheuermann disease was commonly found in weightlifting and manual workers, so mechanical factor may be one of the causes of Scheuermann disease. Scheuermann disease is controllable in majority patients treated with braces, and surgical treatment is only for those with unrelieved pain by conservative treatment or those with severe kyphosis(over 75°) and progressive severity.