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FAQs of Scheuermann's disease

Dr. Yogesh K. Pithwa

What is Scheuermann’s disease?

Scheuermann’s disease is a disease that afflicts adolescents. It can affect the upper-back, mid-back or the lower back region.

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What causes Scheuermann’s disease?

It is caused by abnormal development of the bones and/ or ligaments of the spine. This leads to wedging of the spinal bones [“vertebrae”].

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How does Scheuermann’s disease manifest?

Pain is the hallmark of this disease. In addition, sometimes, patients can develop a hunchback deformity of the back. This problem is noted only if the disease affects the upper or mid back region and is extremely rare in afflictions of the lower back. Rarely, a severe hunchback deformity can affect the spinal cord function leading to weakness in the lower limbs or clumsiness while walking. This is again most commonly noted in afflictions of the mid back rather than upper back regions.

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How is Scheuermann’s disease treated?

If detected early, this disease can be treated with simple painkillers and physiotherapy. Most often, this is a self-limiting problem. Once the skeletal maturity is attained [once the bony growth is over], the pain subsides of its own. In patients who develop hunchback deformity, spinal bracing may be necessary along with regular observation.

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When is surgery essential?

Surgery is essential when the deformity is progressively increasing on observation or, when the deformity is severe at the time of presentation itself or, when the deformity has led to compromised function of the spinal cord.

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What is the nature of surgery?

The nature of surgery is decided by the severity of the deformity. In severe cases the surgery may be done in two stages, front and back. In most other instances, the surgery would be done from the backside alone. By means of using screws and/ or wires and rods, the spine is corrected back into its normal shape as much as possible. During the surgery, as a routine, the patient would be aroused partly and asked to move his/ her toes after which the last stage of the surgery is finished off.

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Is the surgery safe?

Rather than asking the question as to whether spine surgery is safe; it is more candid to ask as to what are the problems that a patient will face, if he undergoes surgery and what if he does not undergo surgery? What are the benefits a patient will have, if he undergoes surgery and what if he does not undergo surgery? Again, spine surgery is not like cosmetic surgery; i.e. it is not optional! Any learned, well-trained spine surgeon would offer spine surgery only if all other options are reasonably exhausted. This does not mean that spine surgery has no complications at all. Everything that we do in life carries some inherent risk. On a similar ground, spine surgery too has its own share of risks; but any learned, well-trained spine surgeon would offer spine surgery only if the benefits outweigh the risks by a factor of at least 10:1! Also, there have been a lot of advances in the field of spine surgery, which has rendered the knowledge contained in even 10-15 year old textbooks as obsolete! The advent of MRI for preoperative diagnostics has allowed the surgeon to rule out any problems within the spinal cord that might limit the surgical options. The advent of intraoperative imaging such as C-arm and computer-aided navigation has given a very safe option for inserting metal implants into the spine, thus improving the postoperative rehabilitation of these patients and also tremendously increasing the safety levels of these surgeries. The use of operating microscope allows for safe handling of neural tissues, minimizing neurotrauma. All this coupled with numerous scientific studies to study various factors to enhance the efficacy of spine surgery and we have a scenario, where the risks associated with spine surgery are significantly neutralized!

So, if you have a problem that genuinely requires surgery, there is no point in denying yourself the benefits of today’s medical advances! Discuss the details of your surgery and its attendant risks with your doctor to quell any fears and to clear any and every doubt of yours! If you so desire, your doctor can even arrange to give you references of patients who have undergone similar surgeries.

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