Running head: SCHEUERMANN'S DISEASE

THORACIC SCHEUERMANN'S
DISEASE
MEAGAN SISSOM

MIDWESTERN STATE UNIVERSITY

RADS-4733-X31

RODNEY FISHER

JULY 17, 2017

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Thoracic Scheuermann's disease

Scheuermann's disease in the thoracic region of the spine is often referred to as type 1 juvenile
kyphosis (Padilla, Njera, Alvarez, & Villazn, 2015). Type 1 juvenile kyphosis occurs when
three or more vertebrae in the apex region (between the T1 and T8 ) of the spine jam together,
creating an angle greater than five degrees (Padilla et al., 2015).

This disease usually starts developing around childhood, and becomes more apparent around
ages 10-12, slowly progressing with age (Bezalel, Carmeli, Been, & Kalichman, 2014).

Studies have shown Scheuermann's occurs in about 0.4 to 0.8 of both men and women equally
(Padilla et al., 2015). These patients often experience symptoms of back pain and fatigue
(Gokce & Beyhan, 2016). Other symptoms of this disease are fluctuation of vertebrae levels,
compression fractures, disc space reduction, disc degeneration, and kyphosis reaching more
than 40 degrees (Bezalel et al., 2014) .

Current studies have still not discovered what cause Scheuermann's disease (Gokce et al.,
2016).
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Diagnostic Procedures
Producing an image of the Producing an image of the
thoracic spine using computed thoracic spine using magnetic
tomography (CT) (DeMaio, 2011 resonance imaging (MRI)
1. Position patient supine with their head facing forward (Bright, 2011).
1. Position patient supine with their head facing forward (DeMaio, 2011)

2. Place padding around head to prevent head from rotating to the side (Bright, 2011).
2. Instruct patients to slightly raise legs and bend knees (DeMaio, 2011).

3. Align the spinal cord perpendicular to the long axis of thoracic cord (Bright, 2011).
3. Support patients knees and feet with a pillow or a positioning cushion to add pressure on their back
(DeMaio, 2011).
4. In order for diagnosis, MRI imaging must show coverage of vertebra pedicles above and below
effected area (Bright, 2011).
4. In order for diagnosis, CT scans must show cover one vertebra level above and below effected area
(DeMaio, 2011)
5. The Cobbs angle is then used to measure the degree of kyphosis starting from the most top
curve measuring down to where the bottom curve ends, measuring form endplate to endplate
5. The Cobbs angle is then used to measure the degree of kyphosis starting from the most top curve
measuring down to where the bottom curve ends, measuring from endplate to endplate.

A sagittal plane CT reformation image works best A Sagittal plane MRI image works best when
when using this modality to diagnosed viewing symptoms of Scheuermanns disease.
Scheuermanns disease. A Sagittal CT is best at This view helps spot irregular vertebrae levels,
identifying vertebrae height reduction, and herniated disc, and disk space reduction found
crooked vertebrae end-plates found in in Scheuermanns disease (Axelrod et al.,
Scheuermanns disease (Axelrod, Zhu, Lomasney, 2015)
& Wojewnik, 2015)
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Computed Tomography (CT)

NORMAL ABNORMAL
A Spinal cord

B Vertebral body

C Spinous process of T3

D Vertebral endplates

E Posterior longitudinal
ligament
F Anterior longitudinal
ligament

The arrows in figure 4 demonstrate

vertebral compressions causing the
spine to curve at an angle greater
than 40 degrees which is a clear
Figure 4: Midsagittal, CT scan of thoracic
Figure 3: Midsagittal, CT scan of a normal thoracic
spine
sign of Scheuermanns disease. spine demonstrating vertebral compression
http://fadavispt.mhmedical.com/content.aspx?booki fractures in T-5 and T7 (arrows)
d=1899&sectionid=141190387 https://www.cambridge.org/core/books/spin
e-disorders/disorders-of-the-thoracic-spine-
preoperative-assessment-and-surgical-
management/619B52E22F09B96606A8DB
0D6449D5E7
SCHEUERMANN'S DISEASE

Magnetic Resonance Imaging (MRI)

NORMAL A Spinal cord ABNORMAL
B Spinous process of T5

C Vertebral body
D Epidural fat

E Cerebrospinal fluid in
subarachnoid space

F Intervertebral disk (nucleus

pulposus)

G Cauda equina

H Annulus fibrosus

I Anterior longitudinal ligament

J Vertebral end plates

K Posterior longitudinal ligament

Disc space Disc space reduced

Figure 2 clearly shows signs of

disk space reduction and
irregular vertebrae levels in T6-
Figure 1: Midsagittal, T2-weighted MRI of a normal T12, which are symptoms of
thoracic spine (Kelly & Peterson, 2013, p. 184) Scheuermanns disease.
Figure 2: Midsagittal, T-1 weighted MRI of thoracic
spine demonstrating the apex at 61 (cobbs angle)
(Gokce et al., 2016, p. 898)
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Conclusion
MRI is the best modality to use when diagnosing Scheuermanns disease.
MRIs help detect disk space reduction, irregular vertebrae levels, and kyphosis
of the spine, where as CTs can only detect vertebral compression and kyphosis
of the spine. End plate crookedness can be shown on a number of successful
levels using MRI which is required for a correct diagnosis and
treatment(Padilla et al., 2015). Treatment is based on the degree of angle these
crooked plates make when they merge together. A back brace is the proper
treatment for patients with kyphosis with in 55 to 80 degrees (Padilla et al.,
5015). If degree of kyphosis is greater than 80 degrees, surgery is required for
treatment(Padilla et al., 2015).
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References
Axelrod, T., Zhu, F., Lomasney, L., & Wojewnik, B. (2015). Diagnosis: Scheuermanns disease (dysostosis) of the spine.

Orthopedics, 38(1), 66-71. doi:10.3928/01477447-20150105-01

Bezalel, T., Carmeli, E., Been, E., & Kalichman, L. (2014). Scheuermann's disease: Current diagnosis and treatment approach.

Journal of Back and Musculoskeletal Rehabilitation, 27(4), 383-390. doi:10.3233/BMR-140483

Bright, A. (2011). Thoracic spine. In B. Hamilton (Eds.), Planning and positioning in MRI (pp. 74-79). Chatswood, New South

Wales: Churchill Livingstone Elsevier.

DeMaio, D. N. (2011). Reviewing of imaging procedures in computed tomography. In A. Whittier (Eds.), Mosby's exam review

for computed tomography (pp. 21-72). St. Louis; Missouri: Mosby Elsevier.

Gokce, E., & Beyhan, M. (2016). Radiological imaging findings of scheuermann disease. World Journal of Radiology, 8(11),

895901. doi:10.4329/wjr.v8.i11.895

Kelley, L. L., Peterson, C. P. (2012). Spine. In Sectional Anatomy for Imaging Professionals

Padilla, A. H., Njera, J. A. C., Alvarez, S. D. L. C., & Villazn, F. G. (2015). Surgical treatment of Scheuermann s disease by

the posterior approach. Case series. Coluna/Columna, 14(1), 14-17. Retrieved from http://dx.doi.org/10.1590/S1808-

1851201514010R120