Back Pain
SCHEUERMANN DISEASE
Scheuermann disease is a common cause of back pain with a rigid kyphosis or humpback deformity. Disturbance of the vertebral end plates causes anterior vertebral body wedging that results in kyphosis during a growth spurt. The exact etiology of this growth disturbance is unknown.39–42 Age of onset is between 10 and 12 years. Pain and increasing back deformity are the most common presenting symptoms. Physical examination findings include a rigid, humpback deformity that does not correct with back extension (Figure 2). Signs of nerve compression are rare.43 Anteroposterior and lateral radiographs of the spine with the patient standing reveal at least 5 degrees of wedging in at least three adjacent vertebrae44 (Figure 3). Disk space narrowing, end plate irregularities, and scoliosis also may be seen. The deformity increases during adolescent growth spurts, but progression after skeletal maturity is not severe.45,46 Postural roundback is a similar disorder that can be differentiated from Scheuermann disease because patients with postural roundback show no abnormalities on radiographs and their deformity can be corrected with changes in posture or position.