Scheuermann's disease is a degenerative condition where there is an abnormal degree of kyphosis due to multiple Schmorl nodes and anterior vertebral wedging. It is found in primarily 13-17yo with a prevalence of 0.4-8%. It is thought to result from multiple instances of trauma on the immature spineleading to damage to the vertebral endplates through which the discs may then extrude. This damage also delays growth of the anterior spine which results in wedging. It affects the thoracic (75%), thoracolumbar (25%), lumbar (<5%), or rarely cervical regions of the spine. It is often seen in gymnasts, weight lifters, or young adults involved in physical labor.
- Kyphosis of >40deg or thoracolumbar kyphosis >30deg
- Wedging >5deg in three adjacent vertabrae
- Endplate abnormalities or Schmorl's nodes at involved levels
- Narrowed disc spaces, anterior > posterior
- Additionally: 15% will have concommitant scoliosis, apex of kyphosis usually T7 or T8, and kyphosis will not reverse with hyperextension (or when lying on MRI table).
Differential discussion: Postural kyphosis should not have compression fractures or endplate abnormalities. Wedge compression fractures should have a traumatic history and less in the way of multilevel degenerative changes (andis not entirely excluded in this case). Congenital kyphosis would be expected to show vertebral anomalies. Osteogenesis imperfecta tarda would have osteopenia as well as platyspondyly. Ankylosing spondylitis would be expected to have bridging osteophytes, classically ascends the spine,and would not be typical for this age group. Spondyloepiphyseal dysplasia tarda would also be expected to show platyspondyly throughout and abnormal epiphyes.
Taking all this into account, Scheuermann's disease would seem the most likely diagnosis for this recruit.