MyPACS.net: Radiology Teaching Files > Case 53598187

Last visited 07/22/2011 SCHEUERMANN'S DISEASE
Contributed by: Charles Hounshell, Evans Army Community Hospital MEDDAC, Colorado, USA.
Patient: 21 year old male
History: 21 year old male in basic training presents to clinic for midback pain. Plain radiographs are obtained followed by MR.
Images:[small]larger

Fig. 1: CR

Fig. 2: CR

Fig. 3: T2

Fig. 4: T1

Fig. 5: STIR
Findings:

Plain film: There is a superior endplate fracture of T8 and anterior wedge compression fracture of T7 and T9, which is age-indeterminate. There is focal kyphosis of approx 53 degrees with apex in this region. Multilevel degenerative changes of T7-T12.


MR:There is anterior wedging of the T7-9 vertebral bodies with 10% height loss at T7, 50% height loss in the center of T8, 25% height loss anteriorly at T9. The apex of the kyphosis is centered at this level. Levels T7-12 demonstrate Schmorl's nodes. There are no signal abnormalities consistent with acute changes/marrow edema.

Diagnosis: Scheuermann's Disease
Discussion:

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.

Diagnosis:

  • 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.

References:

Ross, JS. Diagnostic Imaging: Spine Amirsys, Salt Lake City. 2004

Wheeless, CR. Wheeless' Textbook of Orthopedics Accessed 7/22/2011 at www.wheelessonline.com

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Additional Details:

Case Number: 53598187Last Updated: 2011-07-22
Anatomy: Spine and Peripheral Nervous System   Pathology: Other
Modality: Conventional Radiograph, MRAccess Level: Readable by all users

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