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InnerFireCircle

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Mar 18 13 2:02 AM

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Scheuermann's disease

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Scheuermann's disease
Classification and external resources

A 20 year old male with Scheuermann's disease, showing various measurement of kyphotic/lordotic degrees and their supplementary angles. Notice the signature 'wedging' shape of the four vertebrae in the lower thoracic area. The other vertebral bodies are otherwise normal. The measured kyphosis for this patient is ~70°.
ICD-10 M42.0
ICD-9 732.0
OMIM 181440
DiseasesDB 11845
eMedicine orthoped/555 pmr/129
MeSH D012544
A pre-operative image of a 22-year-old male with Scheuermann's disease

Scheuermann's disease (pron.: /ˈʃərmən/, though very often mispronounced as 'Sherman') is a self-limiting skeletal disorder of childhood. It is also known as Scheuermann's kyphosis (since it results in kyphosis), Calvé disease, and juvenile osteochondrosis of the spine. It is named after Holger Werfel Scheuermann.[1][2][3] Scheuermann's disease describes a condition where the vertebrae grow unevenly with respect to the sagittal plane; that is, the anterior angle is often greater than the posterior. This uneven growth results the signature "wedging" shape of the vertebrae, causing kyphosis.

Contents

Presentation

Scheuermann's disease is considered to be a form of juvenile osteochondrosis of the spine. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. Patients suffering with Scheuermann’s kyphosis cannot consciously correct their posture. The apex of their curve, located in the thoracic vertebrae, is quite rigid.

Scheuermann's disease is notorious for causing lower and mid-level back and neck pain, which can be severe and disabling. The sufferer may feel pain at the apex of the curve, which can be aggravated by physical activity and by long periods of standing or sitting; this can have a significantly detrimental effect to their lives as their level of activity is curbed by their condition and they may feel isolated or uneasy amongst their peers if they are children, depending on the level of deformity.

In addition to the pain associated with Scheuermann's disease, many sufferers of the disorder have loss of vertebral height, and depending on where the apex of the curve is, may have a visual 'hunchback' or 'roundback'. It has been reported that curves in the lower thoracic region cause more pain, whereas curves in the upper region present a more visual deformity. Nevertheless, it is typically pain or cosmetic reasons that prompt sufferers to get help for their condition. In studies, kyphosis is better characterized for the thoracic spine than for the lumbar spine.[4][5]

The seventh and tenth thoracic vertebrae are most commonly affected. It causes backache and spinal curvature. In very serious cases it may cause internal problems and spinal cord damage, but these cases are extremely rare. The curvature of the back decreases height, thus putting pressure on internal organs, wearing them out more quickly than the natural aging process; surgical procedures are almost always recommended in this case.

Comorbid conditions

Many with Scheuermann's disease often have an excessive lordotic curve in the lumbar spine; this is the body's natural way to compensate for the kyphotic curve above. Interestingly, many with Scheuermann's disease have very large lung capacities and males often have broad, barrel chests. Most people have FVC scores above average. It has been proposed that this is the body's natural way to compensate for a loss of breathing depth.

Often patients have tight hamstrings, which, again, is related to the body compensating for excessive spinal curative, though this is also debated (for example, some suggest the tightness of ligament is the initial cause of the growth abnormality). In addition to the common lordosis, it has been suggested that between 20–30% of patients with Scheuermann's Disease also have scoliosis, though most cases are negligible. In more serious cases, however, the combination is classified as a separate condition known as kyphoscoliosis.

Causes

The cause is not currently known, and the condition appears to be multifactorial.[6] Several candidate genes (such as COL1A2, which has been associated with Marfan syndrome) have been proposed and excluded.[7]

Conservative treatment

Scheuermann's disease is self-limiting after growth is complete, meaning that it generally runs its course and never presents further complication. Typically, however, once the patient is fully grown, the bones will maintain the deformity. For this reason, there are many treatment methods and options available that aim to correct the kyphosis while the spine is still growing, and especially aim to prevent it from worsening.

While there is no explanation for what causes Scheuermann's Disease, there are ways to treat it. For decades there has been a lot of controversy surrounding treatment options. For less extreme cases, manual medicine, physical therapy and/or back braces can help reverse or stop the kyphosis before it does become severe. Because the disease is often benign, and because back surgery includes many risks, surgery is usually considered a last resort for patients. In severe or extreme cases, patients may be treated through an extensive surgical procedure in an effort to prevent the disease from worsening or harming the body.

In Germany, a standard treatment for both Scheuermann's disease and lumbar kyphosis is the Schroth method, a system of specialized physical therapy for scoliosis and related spinal deformities.[8] The method has been shown to reduce pain and decrease kyphotic angle significantly during an inpatient treatment program.[9][10]

Surgery

A post-operative X-ray of a 22-year-old male with Scheuermann's disease. After a 13-level spinal fusion to correct the excessive curvature, the patient now presents a normal degree of kyphosis, with a minimal loss of flexibility.

Scheuermann's disease can be successfully corrected with surgical procedures, almost all of which include spinal fusion and hardware instrumentation, i.e., rods, pedicle screws, etc. While many patients are typically interested in getting surgery for their correction, it is important to realize the surgery aims to reduce pain, and not cosmetic defect. As always, surgical intervention should be used as a last resort once conservative treatment fails or the patient's health is in imminent danger as any surgical procedure is not without risk; however, the chances of complication are relatively low and the surgeries are often successful.

One of the largest debates surrounding Scheuermann's disease correction is the use of very different correction procedures. There are different techniques to correct kyphosis; usually the differences being posterior/anterior entry or posterior entry (rear) only. The classic surgical procedure partially entails entering two titanium rods, each roughly one and a half feet long, into the back on either side of the spine. Eight titanium screws and hardware are drilled through the bone and secure the rods onto either side of the spine. On the internal-facing side of the spine, ligaments (which can be too short, pulling the spine into the general shape of kyphosis) must be surgically cut or released, not only stopping part of the cause of the kyphosis, but also allowing the titanium rods to pull the spine into a more natural position. Normally, the damaged discs between the troubled vertebrae (wedged vertebrae) are removed and replaced with cartilage from the hip or other parts of the vertebrae, which once healed or 'fused' will solidify. The titanium instrumentation holds everything in place during healing and is not necessary once fusion completes. Recovery begins in the hospital and depending on whether the operation is one- or two-stage the patient can expect to be in hospital for minimum of a week, possibly longer depending on recovery. They will then often be required to wear a brace for several months to ensure the spine heals correctly leaving the patient with the correct posture. The titanium instrumentation can stay in the body permanently, or be removed years later. Patients undergoing surgery for Scheuermann's disease often need physical therapy to manage pain and mobility, however their range of motion is generally not limited very much. Recovery from kyphosis correction surgery can be very long; typically patients are not allowed to lift anything above 5 or 10 pounds for 6 months to a year. Many are out of work for at least 6 months. However, once the fusion is solidified, most patients can return to their usual lifestyle within one to two years.

Prognosis

Spinal fusion for kyphosis and scoliosis is an extremely invasive surgery. The risk of complications is estimated to be about 10%. Possible complications may be inflammation of the soft tissue or deep inflammatory processes, breathing impairments, bleeding and nerve injuries. As early as five years after surgery around 5% require reoperation and long-term issues remain unclear.[11][12] Taking into account that signs and symptoms of spinal deformity cannot be changed by surgical intervention, surgery remains to be a cosmetic indication,[11][13] though the cosmetic effects of surgery are not necessarily stable.[11]

Notable people with the condition

References

  1. ^ synd/3305 at Who Named It?
  2. ^ H. W. Scheuermann (1920). "Kyphosis dorsalis juvenilis". Ugeskrift for Læger, Copenhagen 82: 385–393.
  3. ^ "Medcyclopaedia – Scheuermann's disease".[dead link]
  4. ^ Summers BN, Singh JP, Manns RA (2008). "The radiological reporting of lumbar Scheuermann's disease: an unnecessary source of confusion amongst clinicians and patients". Br J Radiol 81 (965): 383–5. doi:10.1259/bjr/69495299. PMID 18440942.
  5. ^ Blumenthal SL, Roach J, Herring JA (1987). "Lumbar Scheuermann's. A clinical series and classification". Spine 12 (9): 929–32. doi:10.1097/00007632-198711000-00015. PMID 3441839.
  6. ^ Fotiadis E, Kenanidis E, Samoladas E, Christodoulou A, Akritopoulos P, Akritopoulou K (2008). "Scheuermann's disease: focus on weight and height role". Eur Spine J 17 (5): 673–8. doi:10.1007/s00586-008-0641-x. PMC 2367416. PMID 18301929.
  7. ^ McKenzie L, Sillence D (1992). "Familial Scheuermann disease: a genetic and linkage study". J. Med. Genet. 29 (1): 41–5. doi:10.1136/jmg.29.1.41. PMC 1015820. PMID 1552543.
  8. ^ Lehnert-Schroth, Christa (2007). Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine. (Palo Alto, CA: The Martindale Press): 185–187, 211–17, and passim.
  9. ^ Weiss HR, Dieckmann J, Gerner HJ (2002). "Effect of intensive rehabilitation on pain in patients with Scheuermann's disease". Stud Health Technol Inform. 88: 254–7. PMID 15456045.
  10. ^ Weiss HR, Dieckmann J, Gerner HJ (2002). "Outcome of in-patient rehabilitation in patients with M. Scheuermann evaluated by surface topography". Stud Health Technol Inform. 88: 246–9. PMID 15456043.
  11. ^ a b c Hawes M. (2006). "Impact of spine surgery on signs and symptoms of spinal deformity". Pediatr Rehabil. 9 (4): 318–39. PMID 17111548.
  12. ^ Weiss HR, Goodall D (2008). "Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature". Scoliosis 3: 9. doi:10.1186/1748-7161-3-9. PMC 2525632. PMID 18681956.
  13. ^ Hawes MC, O'Brien JP (2008). "A century of spine surgery: What can patients expect?". Disabil Rehabil 30 (10): 808–17. doi:10.1080/09638280801889972. PMID 18432439.
  14. ^ Shinzawa, Fluto (2007-10-18). "Bruins rookie Lucic punches up résumé – The Boston Globe". Boston.com. Retrieved 2010-08-31.
  15. ^ "One Year On George Sampson". The Times (London). 2009-05-17. Retrieved 2010-05-23.

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eyes of fire

InnerFireCircle

Posts: 553

#1 [url]

Mar 18 13 2:29 AM

now i know why it was described to me by doctor's but never named and why i spent alot of time on the bench as a child? damn the doctor who cheats a child of knowing what's wrong with him? who fails to name it and leaves the child to make excuses for a genetic disease he can not name? or the hospitals that seal records and failed to diagnosis it but say it was all in my mind? who is then damaged in suspisous accidents that were no accident, overdosed for an eye infection on horse pills of penisillian and then ofloaxin? interaction cause aliphatic shock and i swelled and almost died if it wasn't for my fifteen month old girl crying and slapping and clawing my face after i past out and hit the floor with her in my arms? and how the macmaster hospital over dosed me on a total of six thousand mgs of pregnistone, benadrill and epaneferin over three days? and now with this piece of my health care puzzle piece in place, who the hell do i sue? i can not turn to any doctor here and trust them, withholding and sealing my files away from the CPPD? CANADA PENSION PLAN DISABLILTY....? the provincial office returning my xrays from the accident that was no accident which bare no post mark from ottawa?

and why were those xrays withheld for two and half years after i could claim proof of injury with MPIC? see i am not stupid, but this province is full of %%%% and corrupt and cruel, i really have only seen one crown employee with honor integrity and compasion, the true herald behavior of a good faith gentlemen. as for the rest of the "crown employee's" in my way: i repeal your col nidre, and one day i will defile your oaths and bonds "OFFICALLY" and deport you, law and love and rights in life is by the perspective of the land: not the corporate slavery and delusions of authority grandeur with private contracts and an oath that says you do not break your vow! but you can: break any agreement or contract for the rest of the year? because all the other crown employee bullies have your back? isn't that rather poorly-lit of you? your in a position of trust, you are accountable for fraud and incompetent boundaries and breach of trust and treason and you are the debtors, time to pay the rent please, our people are starving at our own expense as you hold your illusionary fairy tale to our heads? is that why we fill 40% of your jails? i asked you to surrender for correction, and you beat and tortured me and broke my chest and re-herniated my broken neck and spine in return? see the problem is all crown employee's are under contract with me, your silence was accepted for value of surrender and i removed your col nidre oath, but you ignored my warnings to correct your behavior, if you read that above you would see its affect neanderthals, not humans...hmmm? your science is bad, your medicine a horror, your policy corrupt, and LAW is illusions and deceptions as your hearts are filled with ash, but thats only how i feel about you of course, get off my land.....

so sad using bully psychology to control me and hurt my family, starve us on "BENEFIT" not benefit, those without shame or compassion are either dead inside, from another planet, or collude as bad man contractor's licensed by the pope, who incidently stepping down: nulls all your oaths and bonds and license, you are completely liable for non-responsibilty in the course of your commerce: prove it other wise. most high scott phillip hayes, (i must be most high to cope with this corporate crap.)

Last Edited By: eyes of fire Mar 18 13 2:57 AM. Edited 2 times.

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Prairyearth

InnerFireCircle

Posts: 1,285

#3 [url]

Apr 29 13 8:54 AM

White-coats who with hold medical diagnosis

So sorry to hear that you suffer from Scheuerman's Moon. Why did the PTB not say anything? This is terrible to with hold info.

I've been accidentally finding out information about Bruce's and my own various medical diagnosis. Some of these medical conditions we have been living with for years! Why won't Doctors inform patients of their own medical diagnosis? Shameful! 

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eyes of fire

InnerFireCircle

Posts: 553

#4 [url]

Apr 30 13 4:00 PM

prairy you know as well as i do they only inform patients who they can profit from. :)

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eyes of fire

InnerFireCircle

Posts: 553

#5 [url]

Aug 6 15 3:05 PM

hmm... what you don't know is that seven oaks hospital helped cover up for the rendition and the legal aide lawyer in eight months had no will to get them, despite my pressure for her to do her job, i let her go because she is really a demon, says one thing at the same time as leave her intercom button on the phone, but it doesn't matter does it? when this comes full circle i won't know how to deal with it; my compassion says i have to protect the weak the ignorant and the stupid from themselves; thus the notices. i did happen to notice again there are still posts missing within strings too, and prairy says we have no back up. oh well good luck with your turns at this on going genocide, let it be said; "i said too much to be ignored by so many." i warned you all these years and all my warnings became real. odd isn't it?

noblesse oblige: the strong protect the weak.
hh the man in the moon.

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eyes of fire

InnerFireCircle

Posts: 553

#6 [url]

Nov 20 15 1:13 PM

interesting how "80%" became "40%" ??

hey its time you crown employee's face the facts; i have been playing this game of yours since you learned that i learned who i am in all this CORPORATE FICTION; and you gave me nothing but "FAIR GO" as i learned in the fictional land of OZ mean's: it means not fair at all and THEY dump all this shit on you and pretend it looks LEGAL.. enough games; i am not prepared to forgive nor forget, you could have seasoned me without harm, you could have invested in me to save the lot of YOU; but you didn't did you? see now i have mental issue's apparently, it only took my doctor ten years to notice! despite telling him why, despite informing him of MK ULTRA, despite it ALL: YOUR CRIMINAL'S, if YOU end up in jail or on tundra: don't wine to me or mine about it, we won't be able to hear you anyway. is it fun to play GOD? is it somehow satisfying that i have reduced all your claims in time to fraud? what power is there owning so many slaves? you had a great run didn't you? how many thousand's of years before i caught up to you? and to think you split my personality to make me into the SHEMALE-ANTI-CHRIST?? thats pretty sick and sadistic, and oddly somehow legal? see all you had to do was meat me halfway in this but instead you nearly killed me? so if i don;t get teary over your present personal debacle, at least you know why. YOU created "IT" and as the present pope said: "you are responsible for what you create." and so is "HE" i wish you weren't so desperate to use me for co-intell operations: but since you never actually contracted with me for this disservice and torture: YOU ARE LIABLE COMPLETELY. please let your design-ate prime minister that he and should talk about your stay. hh the man in the moon. 

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eyes of fire

InnerFireCircle

Posts: 553

#7 [url]

Nov 20 15 1:16 PM

this masonic chess game is over: YOU have no king; your QUEEN is a CORPORATION; the bishops are immoral; the KNIGHT'S are drunk with power; and the CASTLE'S are falling down and the rest of YOU'S are PAWN'S.. since i am the only real king on this game board: checkmate in six moves. thank you for watching WATCH WATCHER'S AND HOTCH HOTCHER'S: game over.

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eyes of fire

InnerFireCircle

Posts: 553

#8 [url]

Feb 24 16 1:12 PM

lololololololololol

(shhh.. found out those last two CCPD APPLICATIONS were never entered in ottawa, thanks for wasting my time; and the proof of YOUR FRAUD.)

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