I'm 25-years-old and feeling old. Turning a quarter-of-a-century has really caught my attention. One thing that keeps coming to mind is the fact that I had Scheuermann's kyphosis as a teenager. I've avoided wearing a bathing suit every since. Now and then my back hurts and feels "twingy." Is this from the kyphosis? What can I expect over the next 25 years? Am I going to get worse?
You are asking about the natural history of a condition still called Scheuermann's disease or Scheuermann's kyphosis. Scheuermann's disease (also called Scheuermann's kyphosis) is named after the physician who first described the condition. It is an excess of thoracic kyphosis (when viewed from the side, this is a C-shaped curvature of the mid-back). The section of spine from below the neck to the bottom of the rib cage is called the thoracic spine.
From the side, the thoracic spine appears slightly rounded. Its shape is like the letter "C" with the opening facing the front of the body. This normal curve is called kyphosis. With excessive kyphosis, the thoracic spine takes on a hunchbacked appearance. With Scheuermann's kyphosis, there is wedging of five-degrees or more affecting at least three consecutive vertebrae. The structural changes that form this type of hyper-kyphosis are seen on X-rays.
In a recently published article, surgeons from the Combined Orthopaedics Residency Program at Harvard Medical School put together a review of the evaluation and management of Scheuermann's kyphosis for adults. They included discussion of who is affected, cause of the disease, pathogenesis (what happens with this condition), and clinical presentation (signs and symptoms).
What is the natural history of Scheuermann's? Besides having a forward curved spine, most people affected by Scheuermann's report back pain, stiffness, and loss of flexibility. The neck and low back try to compensate by increasing the natural lordotic curves in these two areas. Since the person cannot straighten the thoracic spine, the cervical and lumbar spines increase their curves to compensate for the round back. All of these changes in posture are usually accompanied by tight shoulder, hip, and leg muscles.
There is an increased awareness of physical appearance among those adults with Scheuermann's. Those who do not get proper treatment for the condition during childhood often experience severe back pain from the spinal deformity as adults.
Studies over three decades (30 years) reveal varying results. Some studies have shown that adults with Scheuermann's are just as well-educated as those of similar age who don't have this condition. Although adults with Scheuermann's kyphosis have less demanding jobs compared with the age-matched control group, the Scheuermann's group do not miss work or use more pain medication than the control group.
Degenerative spondylosis is also reported as part of the natural history in middle-aged adults with Scheuermann's kyphosis. Degenerative changes in the spine (usually from aging) can cause bone spurs to form around the spinal joints. The joint spaces start to narrow. This condition is called spondylosis.
Treatment for the adult with Scheuermann's kyphosis may not be needed but ranges from conservative care with antiinflammatory medications and physical therapy to surgery to either keep the deformity from getting worse or possibly improve or correct the curvature. Physical therapy is a key part of the nonsurgical management of adult kyphosis.
Exercises to improve strength and posture won't straighten the spine but will improve general conditioning and help reduce pain. Core training is an important part of the exercise management program. Some adults try using a brace but most do not like the brace because it is too confining and uncomfortable. Bracing is most likely to be recommended to or tried by adults who are not good candidates for surgery.
Surgery is primarily focused on providing patients with pain relief. This applies most often to those patients who have tried nonsurgical treatment without a change in their painful symptoms. In some cases, appearance is the main reason surgery is done. Spinal fusion is the most common surgical technique used for this condition.
Kirkham B. Wood, MD, et al. Adult Scheuermann Kyphosis: Evaluation, Management, and New Developments. In Journal of the American Academy of Orthopaedic Surgeons. February 2012. Vol. 20. No. 2. Pp. 113-121.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.