Scheuermann Disease¶

Definition¶

Scheuermann disease is a developmental disorder of the thoracic spine characterized by abnormal endplate ossification leading to vertebral body wedging, endplate irregularity, Schmorl nodes, and progressive thoracic kyphosis. It is the most common cause of structural kyphosis in adolescents and is defined radiographically as anterior wedging of ≥5 degrees in three or more consecutive vertebral bodies.

Imaging Findings¶

Radiography (Diagnostic)¶

Anterior wedging — ≥5 degrees in three or more consecutive thoracic vertebral bodies (Sorensen criteria)
Endplate irregularity — Wavy, irregular endplates from abnormal endplate ossification
Schmorl nodes — Herniations of disc material through the weakened endplates into the vertebral body
Disc space narrowing — At the affected levels
Increased thoracic kyphosis — Kyphosis often exceeds 45 degrees (normal thoracic kyphosis is 20–45 degrees)
Limbus vertebra — Anterior herniation of disc material through the ring apophysis

MRI¶

Schmorl nodes — Well-demonstrated on MRI as disc material herniating through the endplate, with or without surrounding marrow edema
Disc dehydration — Low T2 signal at the affected levels
Endplate irregularity — Corresponding to the radiographic findings
Active Schmorl nodes may show surrounding STIR hyperintensity (edema) indicating an acute or subacute phase

CT¶

Endplate irregularity and Schmorl nodes
Anterior vertebral body wedging
Useful for surgical planning

Clinical Pearl

Scheuermann disease is diagnosed on lateral radiograph using the Sorensen criteria: anterior wedging of ≥5 degrees in ≥3 consecutive vertebral bodies. It must be distinguished from postural kyphosis (round back), which is flexible and corrects on extension. Scheuermann kyphosis is structural and does NOT correct on extension. MRI is obtained when neurological symptoms are present (rare — disc herniation or cord compression from severe kyphosis).

Atypical (Lumbar) Scheuermann Disease¶

A variant involving the thoracolumbar junction or lumbar spine, characterized by endplate irregularity and Schmorl nodes without significant kyphosis. More common in young athletes and manual laborers.

Management¶

Mild — Observation, physical therapy, postural exercises
Moderate (kyphosis 50–75°) — Bracing (Milwaukee brace) during growth
Severe (kyphosis >75°) — Surgical correction with posterior spinal fusion

Key Points¶

Most common cause of structural kyphosis in adolescents
Sorensen criteria: ≥5° anterior wedging in ≥3 consecutive vertebral bodies
Endplate irregularity, Schmorl nodes, and disc narrowing are hallmarks
Structural kyphosis does not correct on extension (unlike postural kyphosis)
Lateral radiograph is the primary diagnostic study
MRI for neurological symptoms or surgical planning

References¶

Mansfield JT, Bennett M. Scheuermann Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499966/
Scheuermann disease. Radiopaedia.org. Available from: https://radiopaedia.org/articles/scheuermann-disease-2
O'Donnell JM, Wu W, Youn A, Mann A, Swarup I. Scheuermann Kyphosis: Current Concepts and Management. Curr Rev Musculoskelet Med. 2023;16(11):521–530. doi:10.1007/s12178-023-09861-z. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10587050/
Gokce E, Beyhan M. Radiological imaging findings of Scheuermann disease. World J Radiol. 2016;8(11):895–901. doi:10.4329/wjr.v8.i11.895. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5120249/
Bezalel T, Carmeli E, Kalichman L. Scheuermann's Disease: Radiographic Pathomorphology and Association with Clinical Features. Asian Spine J. 2018;13(1):86–95. doi:10.31616/asj.2018.0025. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6365786/
Viroslav A. Scheuermann's Disease. Radsource MRI Web Clinic. April 2018. Available from: https://radsource.us/scheuermannsdisease/