Scheuermann's disease: current diagnosis and treatment approach

Objectives: To summarize the current knowledge relating to diagnosing and treating Scheuermann's disease. Scheuermann's disease is the most common cause of structural kyphosis in adolescence.

Methods: A literature-based narrative review of English language medical literature.

Results and conclusions: Recent studies have revealed a major genetic contribution (a dominant autosomal inheritance pattern with high penetrance and variable expressivity) to the etiology of Scheuermann kyphosis with a smaller environmental component (most probably mechanical factors). The natural history of Scheuermann kyphosis remains controversial, with conflicting reports as to the severity of pain and physical disability. Since we cannot predict which kyphotic curves will progress, we are unable to determine effectiveness of brace treatment. Physical therapy is scarcely mentioned in the literature as an effective treatment for Scheuermann kyphosis. Although there is little evidence that physical therapy alone can alter the natural history of Scheuermann's disease, it is often used as the first choice of treatment. Brace treatment appears to be more effective if an early diagnosis is made, prior to the curvature angle exceeding 50° in patients continuing to grow. Surgical treatment is rarely indicated for severe kyphosis (>75°) with curve progression, refractory pain, or a neurologic deficit. Rigorous methodology clinical trials are essential to evaluate the efficacy of conservative interventions, especially different exercises and manual therapies and their combinations with braces.