Anatomy
The back is made up of box-shaped vertebrae that are held in place partly by the shape of the bones, partly by ligaments and partly by the large and small back and abdominal muscles.
Scheuermann’s disease in the thoracic spine (left) and normal spinal curvature (right)
Cause
Scheuermann’s disease is caused by a growth disorder of the vertebrae, most commonly affecting boys aged 12–14, i.e. during the growth spurt of puberty. Once a person has finished growing, the condition does not progress any further. The vertebrae become partially fused at the front, giving them a wedge-shaped appearance.
As this growth disorder most commonly affects the vertebrae in the thoracic spine, there is a risk of developing a hunched back (forward curvature). If the vertebrae in the lumbar spine are affected, the natural lumbar curve is lost. 70% of cases of scoliosis are located in the thoracic spine and 30% in the lumbar spine.
This spinal condition affects around 5% of the population. The cause is unknown, but the condition is partly hereditary (O’Donnell JM, et al. 2023).
Symptoms
Occasional fatigue and moderate back pain. Curvatures of the spine located in the upper back (thoracic Scheuermann’s disease) often cause few or no symptoms. Curvatures of the spine located in the lower back (thoracolumbar or lumbar Scheuermann’s disease) cause back pain in most people. The pain and discomfort often subside with age, but the curvature of the spine is permanent.
In very rare cases, nerve compression may occur, leading to increasing pain and loss of sensation and muscle function. Scoliosis is often mistaken for ‘poor posture’ at first.
Examination
The diagnosis is made on the basis of a standard clinical examination supplemented by X-rays (at least three adjacent vertebrae with a wedge-shaped deformity of at least 5 degrees, Schmorl’s nodes, flattening of the discs, and irregular endplates). In some cases, an MRI scan is recommended.
Treatment
The vast majority of cases can be treated with exercise, which aims to maintain mobility in the back, counteract the tendency for the spine to curve, and strengthen the abdominal and back muscles. Sports activities that place the greatest strain on the back can be avoided (e.g. weightlifting).
In some cases, a brace may be worn until the young person has finished growing. In very rare cases, surgery may be performed if the curvature is significant (O’Donnell JM, et al. 2023). The condition has a good prognosis.
Complications
If the pain does not subside after relief and treatment, you should be (re)examined by a doctor.
In particular, the following should be considered:
- Slipped disc
- Secondary muscle infiltrations
- brud på hvirvelbuen (arkolyse)
- skoliose
However, there are many other causes of lower back pain (arthritis, infections, metabolic disorders, nerve disorders, tumours), some of which will require further specialist investigation.