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Radiological signs of Scheuermann disease and low back pain: retrospective categorization of 188 hospital staff members with 6-year follow-up.

Liu N, Guo X, Chen Z, Qi Q, Li W, Guo Z, Zeng Y, Sun C, Liu Z - Spine (2014)

Bottom Line: Rates of lifetime, previous 1-year, and point LBP did not significantly differ between groups.However, among participants who had ever had LBP, SD-like spine was associated with higher rates of work absence (42.1% vs. 9.5%, χ = 9.620, P = 0.002) and seeking medical care (68.4% vs. 39.2%, χ = 5.216, P = 0.022) due to LBP, as well as significantly greater intensity of the most severe LBP episode in the past 2 years (6.4 ± 2.5 vs. 4.1 ± 2.5, t = 3.564, P = 0.001).Our results suggest that in the general population, lumbar MR images of many people meet SD diagnostic criteria, and having SD-like spine seemed to be associated with the severity and progressive nature of LBP.

View Article: PubMed Central - PubMed

Affiliation: *Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and †Department of Orthopaedic Surgery, Spine Service, Massachusetts General Hospital, Boston, MA.

ABSTRACT

Study design: Retrospective cohort study.

Objective: To investigate the relationship between radiological signs of Scheuermann disease (SD) and low back pain (LBP) in a local population using lumbar magnetic resonance (MR) images.

Summary of background data: SD is a spinal disorder, and both its classic and atypical (lumbar) forms are associated with LBP. However, radiological signs of SD are present in 18% to 40% of the general population, in whom the clinical significance of "SD-like" spine remains largely unknown.

Methods: This retrospective cohort study included 188 staff members from a single hospital. Participants' lumbar MR images and self-administered questionnaires concerning demographic information, LBP status, consequences, and functional limitations were collected. Participants were classified into 2 groups according to whether lumbar MR images met SD diagnostic criteria, and LBP status, consequences, and functional limitation were compared. Follow-up interviews were conducted after 6 years to compare LBP progression.

Results: Thirty-four participants (18.1%) had SD-like spine. Rates of lifetime, previous 1-year, and point LBP did not significantly differ between groups. However, among participants who had ever had LBP, SD-like spine was associated with higher rates of work absence (42.1% vs. 9.5%, χ = 9.620, P = 0.002) and seeking medical care (68.4% vs. 39.2%, χ = 5.216, P = 0.022) due to LBP, as well as significantly greater intensity of the most severe LBP episode in the past 2 years (6.4 ± 2.5 vs. 4.1 ± 2.5, t = 3.564, P = 0.001). Among the 159 participants who completed the 6-year follow-up, a significantly higher proportion of people with SD-like spine reported aggravated LBP during the follow-up.

Conclusion: Our results suggest that in the general population, lumbar MR images of many people meet SD diagnostic criteria, and having SD-like spine seemed to be associated with the severity and progressive nature of LBP. Our findings should inspire further research in this field.

Level of evidence: 3.

No MeSH data available.


Related in: MedlinePlus

What makes up “Scheuermann disease”? The definition of SD is not uniform or fixed. Instead, it depends on the form being referred to and a corresponding combination of pathological changes. Classic SD (the upper surface of the cube) is characterized by K and 3 or more WV occurring in the TS. Atypical SD (the left surface) tends to occur in the LS, and patients typically have 1 or 2 WV and lack notable kyphosis, but have characteristic disc/endplate lesions, including SN, IE, and DSN. The 2 forms often overlap in the same patient (the right surface). This comprehensive definition of SD has been accepted by many authors: as of December 31, 2013, a literature search revealed 15 studies (15 national flags representing the nationalities and locations of the primary authors, Table 1) that included specific criteria for diagnosing atypical or lumbar SD. We searched PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) for articles published in English, with the terms “atypical” and “lumbar” in successive combination with the terms “Scheuermann” and “Scheuermann's” in the title/abstract. This search strategy revealed 115 articles, from which these 15 were identified on the basis of the criterion mentioned in the earlier text. SD indicates Scheuermann disease; K, kyphosis; WV, wedged vertebrae; TS, thoracic spine; LS, lumbar spine; SN, Schmorl node; IE, irregular endplate; DSN, disc space narrowing.
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Figure 1: What makes up “Scheuermann disease”? The definition of SD is not uniform or fixed. Instead, it depends on the form being referred to and a corresponding combination of pathological changes. Classic SD (the upper surface of the cube) is characterized by K and 3 or more WV occurring in the TS. Atypical SD (the left surface) tends to occur in the LS, and patients typically have 1 or 2 WV and lack notable kyphosis, but have characteristic disc/endplate lesions, including SN, IE, and DSN. The 2 forms often overlap in the same patient (the right surface). This comprehensive definition of SD has been accepted by many authors: as of December 31, 2013, a literature search revealed 15 studies (15 national flags representing the nationalities and locations of the primary authors, Table 1) that included specific criteria for diagnosing atypical or lumbar SD. We searched PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) for articles published in English, with the terms “atypical” and “lumbar” in successive combination with the terms “Scheuermann” and “Scheuermann's” in the title/abstract. This search strategy revealed 115 articles, from which these 15 were identified on the basis of the criterion mentioned in the earlier text. SD indicates Scheuermann disease; K, kyphosis; WV, wedged vertebrae; TS, thoracic spine; LS, lumbar spine; SN, Schmorl node; IE, irregular endplate; DSN, disc space narrowing.

Mentions: Scheuermann disease (SD) is a spinal disorder named after Dr. Holger Werfel Scheuermann, who, in 1921, first described a structural thoracic kyphosis mainly affecting adolescents.14 Its best-known manifestations are multiple wedged vertebrae (WV) and thoracic kyphosis known as Scheuermann kyphosis. Its classic diagnostic criterion was “3 or more consecutive wedged thoracic vertebrae,” proposed by Sorensen in 1964.15 However, SD pathological changes also include disc and endplate lesions, primarily Schmorl node (SN) and irregular vertebral endplate (IE).14,15 Therefore, the diagnosis of “atypical SD” was proposed for patients with only one or 2 WV and no notable kyphosis, but characteristic disc/endplate lesions, including SN and IE.16–20 Because atypical SD tends to affect the lumbar or thoracolumbar junction region instead of the thoracic spine, it is also called “lumbar SD.”16,17,19,20 Thus, SD represents a broader concept than Scheuermann kyphosis (classic SD) because it also includes lumbar SD (atypical SD) (Figure 1; Table 1).


Radiological signs of Scheuermann disease and low back pain: retrospective categorization of 188 hospital staff members with 6-year follow-up.

Liu N, Guo X, Chen Z, Qi Q, Li W, Guo Z, Zeng Y, Sun C, Liu Z - Spine (2014)

What makes up “Scheuermann disease”? The definition of SD is not uniform or fixed. Instead, it depends on the form being referred to and a corresponding combination of pathological changes. Classic SD (the upper surface of the cube) is characterized by K and 3 or more WV occurring in the TS. Atypical SD (the left surface) tends to occur in the LS, and patients typically have 1 or 2 WV and lack notable kyphosis, but have characteristic disc/endplate lesions, including SN, IE, and DSN. The 2 forms often overlap in the same patient (the right surface). This comprehensive definition of SD has been accepted by many authors: as of December 31, 2013, a literature search revealed 15 studies (15 national flags representing the nationalities and locations of the primary authors, Table 1) that included specific criteria for diagnosing atypical or lumbar SD. We searched PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) for articles published in English, with the terms “atypical” and “lumbar” in successive combination with the terms “Scheuermann” and “Scheuermann's” in the title/abstract. This search strategy revealed 115 articles, from which these 15 were identified on the basis of the criterion mentioned in the earlier text. SD indicates Scheuermann disease; K, kyphosis; WV, wedged vertebrae; TS, thoracic spine; LS, lumbar spine; SN, Schmorl node; IE, irregular endplate; DSN, disc space narrowing.
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Related In: Results  -  Collection

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Figure 1: What makes up “Scheuermann disease”? The definition of SD is not uniform or fixed. Instead, it depends on the form being referred to and a corresponding combination of pathological changes. Classic SD (the upper surface of the cube) is characterized by K and 3 or more WV occurring in the TS. Atypical SD (the left surface) tends to occur in the LS, and patients typically have 1 or 2 WV and lack notable kyphosis, but have characteristic disc/endplate lesions, including SN, IE, and DSN. The 2 forms often overlap in the same patient (the right surface). This comprehensive definition of SD has been accepted by many authors: as of December 31, 2013, a literature search revealed 15 studies (15 national flags representing the nationalities and locations of the primary authors, Table 1) that included specific criteria for diagnosing atypical or lumbar SD. We searched PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) for articles published in English, with the terms “atypical” and “lumbar” in successive combination with the terms “Scheuermann” and “Scheuermann's” in the title/abstract. This search strategy revealed 115 articles, from which these 15 were identified on the basis of the criterion mentioned in the earlier text. SD indicates Scheuermann disease; K, kyphosis; WV, wedged vertebrae; TS, thoracic spine; LS, lumbar spine; SN, Schmorl node; IE, irregular endplate; DSN, disc space narrowing.
Mentions: Scheuermann disease (SD) is a spinal disorder named after Dr. Holger Werfel Scheuermann, who, in 1921, first described a structural thoracic kyphosis mainly affecting adolescents.14 Its best-known manifestations are multiple wedged vertebrae (WV) and thoracic kyphosis known as Scheuermann kyphosis. Its classic diagnostic criterion was “3 or more consecutive wedged thoracic vertebrae,” proposed by Sorensen in 1964.15 However, SD pathological changes also include disc and endplate lesions, primarily Schmorl node (SN) and irregular vertebral endplate (IE).14,15 Therefore, the diagnosis of “atypical SD” was proposed for patients with only one or 2 WV and no notable kyphosis, but characteristic disc/endplate lesions, including SN and IE.16–20 Because atypical SD tends to affect the lumbar or thoracolumbar junction region instead of the thoracic spine, it is also called “lumbar SD.”16,17,19,20 Thus, SD represents a broader concept than Scheuermann kyphosis (classic SD) because it also includes lumbar SD (atypical SD) (Figure 1; Table 1).

Bottom Line: Rates of lifetime, previous 1-year, and point LBP did not significantly differ between groups.However, among participants who had ever had LBP, SD-like spine was associated with higher rates of work absence (42.1% vs. 9.5%, χ = 9.620, P = 0.002) and seeking medical care (68.4% vs. 39.2%, χ = 5.216, P = 0.022) due to LBP, as well as significantly greater intensity of the most severe LBP episode in the past 2 years (6.4 ± 2.5 vs. 4.1 ± 2.5, t = 3.564, P = 0.001).Our results suggest that in the general population, lumbar MR images of many people meet SD diagnostic criteria, and having SD-like spine seemed to be associated with the severity and progressive nature of LBP.

View Article: PubMed Central - PubMed

Affiliation: *Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and †Department of Orthopaedic Surgery, Spine Service, Massachusetts General Hospital, Boston, MA.

ABSTRACT

Study design: Retrospective cohort study.

Objective: To investigate the relationship between radiological signs of Scheuermann disease (SD) and low back pain (LBP) in a local population using lumbar magnetic resonance (MR) images.

Summary of background data: SD is a spinal disorder, and both its classic and atypical (lumbar) forms are associated with LBP. However, radiological signs of SD are present in 18% to 40% of the general population, in whom the clinical significance of "SD-like" spine remains largely unknown.

Methods: This retrospective cohort study included 188 staff members from a single hospital. Participants' lumbar MR images and self-administered questionnaires concerning demographic information, LBP status, consequences, and functional limitations were collected. Participants were classified into 2 groups according to whether lumbar MR images met SD diagnostic criteria, and LBP status, consequences, and functional limitation were compared. Follow-up interviews were conducted after 6 years to compare LBP progression.

Results: Thirty-four participants (18.1%) had SD-like spine. Rates of lifetime, previous 1-year, and point LBP did not significantly differ between groups. However, among participants who had ever had LBP, SD-like spine was associated with higher rates of work absence (42.1% vs. 9.5%, χ = 9.620, P = 0.002) and seeking medical care (68.4% vs. 39.2%, χ = 5.216, P = 0.022) due to LBP, as well as significantly greater intensity of the most severe LBP episode in the past 2 years (6.4 ± 2.5 vs. 4.1 ± 2.5, t = 3.564, P = 0.001). Among the 159 participants who completed the 6-year follow-up, a significantly higher proportion of people with SD-like spine reported aggravated LBP during the follow-up.

Conclusion: Our results suggest that in the general population, lumbar MR images of many people meet SD diagnostic criteria, and having SD-like spine seemed to be associated with the severity and progressive nature of LBP. Our findings should inspire further research in this field.

Level of evidence: 3.

No MeSH data available.


Related in: MedlinePlus