Thoraco-Lumbar Scheuermann’s Disorder

An Overview of Thoraco-Lumbar Scheuermann’s Disorder

This condition was first described in 1921 by Holger Werfel Scheuermann, a Danish surgeon, as an “osteochondrosis”. To understand thoraco-lumbar Scheuermann’s disorder, you have to understand how the vertebral bodies form and develop as the onset of this condition occurs when the patient is an adolescent (from ages 8-15). This problem is considered a genetic disorder.

The vertebral body enlarges through growth plates. These are cartilaginous rings on the top and the bottom of the vertebral body like plastic caps on either end of a can. The cartilaginous rings expand and form bone (cartilage is the precursor to bone). The vertebral body continues to thicken and when fully grown, these rings fuse to the body and become one solid piece of bone. The fusion of these rings occurs generally around the ages of 18-22 even though the bone growth has stopped by about 15 years of age.

There is increased pressure on the front of the vertebra due to the normal alignment of the spine, especially when bending over. For some reason that has yet to be determined, some individuals develop “softer” growth plates on these vertebral bodies in a condition called osteochondrosis. This increased pressure causes injury to the growth plate in front and deforms the vertebra.

In thoraco-lumbar Scheuermann’s disorder, the anterior growth plates (the front of the vertebra) will fragment and sometimes disappear due to this pressure. This means that while the growth plates in the middle and rear of the vertebra continue to grow, the plates in front stop growing. With this mismatch in growth, the vertebra grows into a wedge instead of a barrel shape creating an abnormal forward angulation called a kyphosis. The normal curve is a backwards curve called a lordosis.

This abnormal curve (the kyphosis) then adds insult to injury. The curve actually increases the load on the front of the spine and creates further overload of the vertebra which in turn worsens the situation similar to a snowball rolling downhill getting bigger the further it rolls.

When the patient with this disorder cause impact to his or her spine (as in landing from a jump), it is not uncommon to have a fracture of the endplate of the vertebra occur. Since the endplate is soft, the jelly in the center of the disc pushes on the endplate and this force produces the fracture. The center jelly actually pushes (herniates) into this cavity which is called a Schmorl’s node.

If thoraco-lumbar Scheuermann’s disorder can be diagnosed when the adolescent is still young and still has growth left, the spine can be unloaded by using a brace. With the pressure in front reduced by the brace, the growth rings in front may heal, filling in the defect and preventing the kyphosis.

If not caught in time, this is not the end of the world as thoraco-lumbar Scheuermann’s disorder can “burn out”. The typical scenario is a young man of 19 who has had pain the thoraco-lumbar spine for years and finally, the pain diminishes as the growth plates heal in. The residuals of wedged vertebra and degenerative discs will still be present but these changes may be asymptomatic (not pain producing). However, a significant percentage of individuals who have residual deformity from thoraco-lumbar Scheuermann’s disorder may have thoraco-lumbar pain throughout the rest of their life.

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(Please keep reading below for more information on this condition.)

Conservative Treatment of Thoraco-Lumbar Scheuermann’s Disorder

If the diagnosis is made when there is still growth possible, the patient can be placed in a thoraco-lumbar extension orthosis (TLSO) to unload the front of the spine. The brace needs to be worn when upright for most of the day. Certain exercises can be encouraged (swimming for example) that involve extension (bending backwards). Contact sports and sports that include flexion (cycling for example) should be avoided. Extension stretching and strengthening exercises should be encouraged (strengthening while in the brace, stretching out of the brace).

If the diagnosis is made after the growth plates have healed in, bracing is not helpful. A corset might be pain relieving but should not be worn full time. Again extension exercises are very helpful to condition and strengthen the muscles. These exercises will not correct the curve but will allow the paravertebral muscles to contract “like a guy-wire” to reduce the stress on these painful segments. Chiropractic manipulation can be pain relieving also.

If thoraco-lumbar Scheuermann’s disorder becomes too painful or the kyphosis angulation is greater than 25 degrees, surgery can be contemplated.

To learn more about thoraco-lumbar Scheuermann’s disorder, please contact the practice of Dr. Donald Corenman, spine specialist and back pain doctor in the Vail, Aspen, Denver and Grand Junction, Colorado area.

Related Content

Click to Enlarge. Risser sign. This diagram demonstrates how to determine skeletal maturity by using the growth plate on top of the pelvis.

Click to Enlarge. Stages of the growth of vertebral bodies.

Click to Enlarge. General spinal biomechanics.

Click to Enlarge. Adolescent Scheuermans Disorder. White arrows point to growth rings that have been damaged. Black arrows point to intact growth rings.

Click to Enlarge. Adolescent Scheuermann’s MRI. White arrows point to the endplate injuries. Black arrow points to a Schmorl’s node.

Click to Enlarge. Adult Scheuermann’s disorder. White arrows point to the wedged and elongated vertebra. Endplates are fused.

Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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An Overview of Thoraco-Lumbar Scheuermann’s Disorder

Are you suffering from symptoms of Thoraco-Lumbar Scheuermann’s Disorder?

Conservative Treatment of Thoraco-Lumbar Scheuermann’s Disorder

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About the Author: Donald Corenman, MD, DC