Dorsolumbar kyphosis or Scheuermann's disease

Confusion over dorsolumbar kyphosis and Sheuermann's disease has existed in the literature since the first recorded episodes in 1921. The present article delineates an etiology of back pain that is frequently seen in the adolescent population and is not to be confused with the painless fixed kyphotic deformity so frequently mentioned in the scoliosis literature. These patients with a painful dorsolumbar Sheuermann's disease may well have a traumatic herniation of the disk into the bony vertebral body. This type of x-ray and clinical finding should become familiar to all clinicians dealing with an adolescent population.

Ankylosing spondylitis presenting as spondylodiscitis

Spondylopathy is a relatively common finding in advanced ankylosing spondylitis (AS). However non-infectious spondylodiscitis as an early manifestation of AS seems to be exceptional. In this article, we present such a case in an adolescent.

Spinal deformities in tall girls

In a prospective study, 62 girls who consulted the paediatric department because of tall stature were examined for spinal deformities. Thirteen cases of scoliosis measuring 10 degrees or more were found. Eighteen girls had a thoracic kyphosis of more than 40 degrees and 11 had additional vertebral abnormalities indicating Scheuermann's disease. The incidence of scoliosis and Scheuermann's disease was much higher in our material than normal.

Scheuermann's disease. Clinical and radiological survey of 17 and 18 year olds

This is a study of the incidence and possible predisposing stress factors of Scheuermann's disease (S.D.). 500, 17 and 18 year old, students from the local larger schools, from one country town school and from the local Teachers' Training College, took part. Each student filled in a questionnaire, underwent a simple spinal examination including a clinical assessment of the available passive hamstring stretch, and had a lateral X-ray of the dorsal and upper lumbar spine. 56.3% of the males and 30.3% of the females had X-ray evidence of previous S.D., in varying degrees of severity. Dynamic stress, such as playing sports involving a lot of potential compression stress, weight lifting, and heavy lifting work in spare time and holidays, seem to play little if any part in the pathogenesis of S.D. Tall males and males who had spent more than 2 weeks in bed, due to sickness or injury, were more prone to S.D. Hamstring tightness showed a significant relationship to X-ray evidence for males. In the absence of possible dynamic stress factors it is suggested that prolonged sitting may be an important factor in the pathogenesis of end plate breakdown and thus S.D.

[Diagnosis of vertebral diseases by vertebral biopsy]

Vertebral biopsies were performed in 28 patients, 17 males and 11 females, because of vertebral body and disc changes between June 1978 and May 1982. In two patients biopsy was performed in two segments. Punctures were done in local and superficial anaesthesia of the vertebral body periosteum during continuous fluoroscopy control using Jamshidi's instrumentation. Aspiration and tissue cylinders were evaluated histologically and bacteriologically. There were no complications among the 8 thoracic and 22 lumbar biopsies. A histologic diagnosis could be established in 22 cases (78.6%): plasmocytoma (n = 2), spontaneous deformation of the spine in osteoporosis (n = 3), Scheuermann's disease (n = 1), specific (n = 2) and nonspecific (n = 14) spondylitis. Demonstration of bacteria was possible in 5 out of the 16 cases of spondylitis (31.25%): in two cases tubercle bacilli were demonstrated and once each salmonella group B, Haemophilus aphrophilus and coagulase-negative staphylococci. Only in 6 cases a diagnosis could not be established from the biopsy material.

Incidence of Scheuermann's disease. Preliminary report

This is a report on a study of 96 students aged 17 and 18 at two of our local schools. Each student completed a questionnaire, underwent a simple examination of the spine and a measurement of the passive stretch in the hamstring muscles, and had a lateral X-ray of the dorsal and upper lumbar spine. An overall X-ray evidence of Scheuermann's Disease was detected in 60% of males and 23% of females. The possible significance of these results is discussed.

[Differential diagnosis of early scoliosis in Scheuermann's disease and idiopathic scoliosis (author's transl)]

In order to avoid overtreatment or undertreatment of a beginning scoliosis early differentiation of the clinically unimportant concomitant scoliosis of Scheuermann's disease is essential as against early idiopathic scoliosis, spondyloepiphyseal dysplasia and the fixed round back deformity of adolescents. Scheuermann's scoliosis as opposed to idiopathic scoliosis is characterised by the almost complete lack of vertebral rotation (as with spondyloepiphyseal dysplasia), by a localized unilateral narrowing of the intervertebral space in the a.p. x-ray, as well as by a slight Z- or E-pattern, and a relative shortness of the curves. Simultaneous dorsal kyphosis may be absent. Indispensable is furthermore, the familiarity with the early x-ray signs of Scheuermann's disease in the lateral view as compared with the X-ray of the fixed roundback.

Discitis--a rare early symptom of ankylosing spondylitis

This case report describes a patient who suffered from backache at the age of 12 years. The initial diagnosis was Scheuermann's disease but repeated examinations showed a progressive discitis, without signs of arthritis of the sacro-iliac joints. There was also a recurring effusion of the left knee. Three years later the clinical and radiological evaluation showed irreversible immobilisation of the dorsolumbar spine, whereas the sacro-iliac joints were mildly affected. Discitis seems to be a rare early symptom of ankylosing spondylitis.

[Spinal lesions following modified exercises in adolescent high performance gymnasts]

20 high performance gymnasts between 14 and 22 years of age had an anamnestical, clinical and radiological checkup on the spine in order to assess news training-methods. Radiologically only 3 gymnasts were found to be without any pathological manifestation. 7 cases of M. Scheuermann were located. The other athletes showed degenerative findings of vertebral columns especially in the thoracic-lumbar transition. These degenerative signs, and the fact tht the gymnasts had no spondylosis, are the result of new exercises, which avoid extreme bending load in the lowest segment of the lumbar region. Anamnestical and radiological findings do not correlate. A critical medical screening is necessary before and during high performance training.

[Evaluation of the mineral content of peripheral bones (radius) by photon-absorption technique in normals as well as in patients with various types of bone diseases (author's transl)]

The evaluation of the mineral content of peripheral bones by measuring the photon absorption of the radius has proven to be a valuable method for routine clinical work: for diagnosis, follow-up and control of therapy. While there was a significant difference in the findings of normal persons compared with those of patients suffering from osteoporosis, renal osteodystrophy, osteogenesis imperfecta and skeletal fluorosis, there was no difference between normals and these patients suffering from Bechterew, Scheuermann, coxarthrosis, spondylosis, skoliosis and rheumatoid arthritis. Normal values for the mineral content and width or the radius at the junction of the middle and lower third--based on 8000 examinations--are mentioned.

Dominant inheritance of Scheuermann's juvenile kyphosis

Familial occurrence of Scheuermann's juvenile kyphosis is well known, but no specific mode of inheritance has been recognized. We describe five families in which the disease seems to follow and autosomal dominant pattern of inheritance.

Back pain: osteoarthritis

Back pain is one of the chief complaints of the elderly. It may be either a chronic deep skeletal muscular pain or an acute circumscribed pain arising from nerve-root irritation. The main causes of back pain in older people are: 1) degenerative changes (spondylosis, osteoarthritis, ankylosing hyperostosis); 2) malignancy (multiple myeloma, metastases from carcinoma or lymphoma); and 3) metabolic disorders (osteoporosis, osteomalacia, chondrocalcinosis, Paget's disease). Mechanisms and variations are discussed in detail.