Treatments for Scheuermann’s disease often involve nonsurgical interventions, such as back braces and physical therapy. However, in some cases, surgery may be necessary.

Scheuermann’s disease, or Scheuermann’s kyphosis, is a condition that causes the small bones in the spine, known as vertebrae, to develop into a wedge shape instead of a rectangular shape. As such, this causes the spine to develop at a forward angle as it grows. The term kyphosis describes a pronounced increase in the forward curvature of the upper back.

People with the condition often have back pain, especially during the early teenage years. Treatment options often involve a combination of nonsurgical methods, such as bracing and physical therapy. In rare cases, a doctor may recommend surgery. The approaches doctors use often have a positive effect on a person’s prognosis and outcome.

In this article, we will discuss the treatment options available for Scheuermann’s kyphosis.

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Scheuermann disease is a type of kyphosis that occurs due to the front sections of the vertebrae growing slower than the back sections during childhood. This results in the vertebrae having a wedge shape instead of a rectangular shape, causing a forward curvature of the upper back.

Clinicians may characterize the condition as anterior wedging greater than or equal to 5 degrees in three or more adjacent vertebral bodies in the spine. The spine has a natural “S” curve and provides support for the body’s weight, helping it absorb impacts.

A typical kyphosis refers to a curvature between 20 and 40 degrees. Doctors consider anything outside of this range as hyperkyphosis. As a reference, Scheuermann disease causes a curvature that often falls between 45–75 degrees.

The condition affects about 0.4% to 10% of people in the United States. It often affects teens between the ages of 12–17 and rarely occurs in children under the age of 10. Evidence suggests that the condition affects males and females equally.

In many cases, nonsurgical treatment provides effective relief and correction of Scheuermann’s disease. When deciding on treatment options, a doctor will consider factors such as age, sex, the severity of the curve, and flexibility of the curve. The condition usually stops progressing once a child is older and has stopped growing. Treatments often include a combination of therapies that can include:

  • bracing
  • physical therapy
  • use of NSAIDs
  • stretching
  • lifestyle modifications

Bracing

Bracing is a nonsurgical intervention to help with Scheuermann’s disease. In most cases, the goal of bracing is to help guide the continued development of the spine to straighten it into its natural position. However, bracing will only help straighten the spine in children and teens who are still growing. However, in older individuals who are no longer growing, bracing may help alleviate pain and support the spine.

The brace helps support the spine and keep it in an upright position. The theory is that the extra support in the front helps take pressure off and allow it to grow in more typical proportions.

Several braces are available for treatment. They include:

  • the Milwaukee brace
  • the Kyphologic brace
  • the thoracolumbosacral orthosis-style brace, or Boston brace

Health experts indicate that the Milwaukee brace is the most common treatment for adolescents with a curve of under 75 degrees. The brace has pads to help keep the shoulders pulled back and includes a chin extension.

Physical therapy

Physical therapy involves strengthening the muscles of the back and abdomen so they can provide better support to the spine. The added support can help improve a person’s posture and help alleviate symptoms, though it may not alter the progressive nature of the condition.

Physical therapy for Scheuermann’s disease may incorporate techniques from the Schroth method. This approach incorporates three methodologies:

  • corrective therapeutic exercises focusing on adding resistance to the spine and abdomen muscles
  • special breathing techniques
  • re-education of the neuromuscular system, which helps someone learn how to correct their posture during everyday activities

According to a smaller 2019 study, the Schroth method provided effective treatment to help prevent and treat curvature of the spine relating to Scheuermann disease.

In more severe cases, a doctor may recommend surgery. Potential reasons for surgery can include:

  • curvature greater than 75 degrees with severe rounding
  • curvature greater than 75 degrees with pain
  • severe refractory pain
  • spinal cord compression

The main options for surgery include:

  • posterior spinal fusion
  • anterior spinal fusion
  • a combination of both

The idea behind surgery is to shorten the posterior column, lengthen the anterior column, or both. In short, surgery helps put the spine back into proper alignment and alleviates symptoms relating to Scheuermann’s disease.

All surgery can cause possible complications relating to the procedure and recovery. When surgery occurs around the spine, additional complications may arise.

When working around the spine, one concern is potential neurological damage that can include partial or full paralysis. The risk of neurological damage is high when correcting Scheuermann’s disease, and the risk may increase according to the amount of curvature and correction necessary.

Other possible complications relating to Scheuermann disease include:

  • pseudoarthrosis
  • death
  • hardware failure
  • deformity progression
  • pneumothorax, where air appears in the space outside the lung and the ribcage
  • gastrointestinal obstruction
  • junctional kyphosis
  • persistent postoperative back pain
  • hemothorax, where blood collects between the chest wall and the lung
  • pulmonary emboli
  • infection

Scheuermann’s disease often causes symptoms, such as a forward curve to the spine and pain that often has no preceding event. It can worsen with activity and improves with rest.

  • spine rigidity leading to reduced flexibility and mobility
  • decreased lung capacity that can lead to heart issues
  • fatigue

About one-third of people with Scheuermann’s disease develop scoliosis. Scoliosis typically develops around the same time and is a spinal problem where the spine curves from side to side.

As such, if a parent or caregiver notices that a child or teenager has a rounding of the upper back and is experiencing back pain, it is advisable to consult a healthcare professional.

Treatment for Scheuermann’s disease often involves nonsurgical treatment options, such as bracing and physical therapy. If a person has severe curvature or pain relating to the condition or other techniques are not working, a doctor may recommend surgical correction.