Disc degeneration in scheuermann disease

Paajanen, Hannu; Alanen, A.; Erkintalo, Minna; Salminen, Jouko K.; Katevuo, K.

doi:10.1007/bf00351753

Cited by 74 publications

(34 citation statements)

References 22 publications

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“…4) a range that exceeds the thoracolumbar junction area, suggesting primary SD rather than primary disc degeneration. In addition, the skewed sex ratio (more males) in the TLDH group corresponds well to the literature's description of ''thoracolumbar SD'' [6,7,9] or ''atypical lumbar SD'' [18], and the increased thoracolumbar kyphotic angle (averaging 16.9°) in the TLDH group is suggestive of a mild version of Scheuermann's kyphosis. However, when compared with conventional concepts in SD, two unique characteristics were found in this series of TLDH patients with a high ratio of associated SD.…”

Section: Discussionsupporting

confidence: 85%

“…Second, all patients suffered myelopathy or radiculopathy that warranted surgery, whereas neurological complications of SD; especially, in adults with mild kyphosis, were considered rare in the past [5,19]. Adequate evidence has shown that SD and its radiographic changes promote disc degeneration [6][7][8][9]20]. This was also demonstrated in our study in which SN, IE, PBA and WV were all found to enhance disc herniation in the TLDH group (Table 5).…”

Section: Discussionsupporting

confidence: 72%

“…Interestingly, these changes were all related to another spinal disorder: Scheuermann's disease (SD) [5][6][7][8][9][10][11][12]. SD was initially named after Scheuermann's first description of a structural thoracic kyphosis with more than 3 wedged vertebrae that mainly affected adolescents [5], but it was subsequently recognized that other than Scheuermann's kyphosis, the pathological changes of SD involved disc lesions characterized by the above features, most commonly at the lumbar and thoracolumbar regions [6][7][8][9][10]. Moreover, there was a portion of SD patients who manifested disc lesions and only one or two wedged vertebrae but did not have significant Scheuermann's kyphosis.…”

Section: Introductionmentioning

confidence: 99%

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The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease

Liu

Chen

et al. 2013

Eur Spine J

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Purpose Symptomatic disc herniations in the thoracolumbar spine between T10/11 and L1/2 can be collectively called thoracolumbar disc herniation (TLDH). The etiology of this disorder is unclear. However, it is interesting that we have noted numerous TLDH patients have radiographic features of another spinal disorder which is Scheuermann's disease (SD). The purpose of this study is to investigate the relationship between symptomatic TLDH and SD in a symptomatic TLDH cohort. Methods A cohort of 63 patients with symptomatic TLDH, who had surgery was investigated. Incidences of associated SD and four radiographic signs of SD that were Schmorl's node, irregular vertebral end plate, posterior bony avulsion of the vertebra and wedge-shaped vertebra, average thoracolumbar kyphotic angle and incidences of disc herniation at segments with and without radiographic signs of SD were examined. Data from the TLDH group were compared with 57 patients undergoing surgery for lower lumbar disc herniation (LDH, L3/4-L5/S1) in the same period. Results The incidences of the four radiographic signs of SD and the incidence of associated SD were all significantly higher in the TLDH group than in the LDH group. 95.2 % of the patients in the TLDH group were diagnosed with SD (either classical SD or its atypical form). The average thoracolumbar kyphotic angle of the TLDH group was 16.9°, while that of the LDH group was 7.6°( P = 0.000). In the TLDH group, the incidences of disc herniation at segments with radiographic signs of SD were all significantly higher than at segments where no sign of SD was found. Conclusions The high proportion of associated SD and the tendency of SD's signs to promote disc herniation in symptomatic TLDH patients suggest a close relationship between these two disorders. Symptomatic TLDH should be seen as a truly different surgical entity, that is, a special form of SD rather than just an indicator of a failing back.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

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The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease

Liu

Chen

et al. 2013

Eur Spine J

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“…An injury to the vertebral body endplate has been found to provide a potent mechanical stimulus for disc degeneration [20] and tissue trauma following fracture has been suggested to cause accelerated intervertebral disc degeneration [10]. Schmorl lesions have been found to be associated with disc degeneration [10,19].…”

Section: Discussionmentioning

confidence: 99%

MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

et al. 2008

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Subchondral signal abnormalities have been suggested to play an important role in chronic low back pain (LBP) syndromes. Their natural course is not well known. In this study the morphology and natural course of isolated subchondral signal abnormalities in the lumbosacral spine were analyzed with MRI. Twenty-four chronic LBP patients with a subchondral hypointensity on T1-weighted image (hyperintense on T2), indicating edema, were selected from a base population of 1,015 consecutive LBP patients to a follow-up MRI study within 18-72 months. Exclusion criteria were age [60 years, nerve root compression, a more specific back disease or a recent or major spine operation. The size and location of each subchondral signal abnormality and endplate lesion and the degree of degenerative disc changes were evaluated and compared between the baseline and follow-up studies. Most subchondral hypointensities were found at the L4/L5 or L5/S1 disc space, anteriorly and in both adjacent endplates. Almost all (53/54) hypointensities were associated with an endplate lesion. Twelve of the 54 subchondral hypointensities enlarged, six remained constant and 36 decreased or disappeared while five new ones appeared. Twenty-two (41%) hypointensities changed totally to hyperintensities or to mixed lesions. If the hypointensity increased, decreased or changed into hyperintensity, a change tended to develop in the adjacent endplate. If the hypointensity was absent or unchanged, endplate lesions did not tend to progress. In the absence of disc herniation or other specific spinal disease, subchondral hypointensities indicating edema are uncommon. They seem to have a highly variable course. There appears to be a link between endplate lesions and subchondral signal abnormalities. Further study is needed to explain the contribution of these findings to low back symptoms.

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“…Schmorl's nodes can mainly be found in the thoracic and lumbar spine and they are common in the spines in the elderly, but their frequency is similar in the younger population [7] and are often a manifestation of Scheuermann disease, which is known to enhance premature disc degeneration [8][9][10].…”

mentioning

confidence: 99%

Georg-Schmorl-Prize of the German Spine Society (DWG)

Wilke

2011

Eur Spine J

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Disc degeneration in scheuermann disease

Cited by 74 publications

References 22 publications

The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease

The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease

MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

Georg-Schmorl-Prize of the German Spine Society (DWG)

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