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Scheuermann's Disease of the Lumbar Spine in Identical Twins

Oregon Health Sciences University, Portland, OR 97210-3098

Scheuermann's disease is a spinal deformity characterized by irregularities of the vertebral endplates, the presence of Schmorl's nodes, disk-space narrowing, and vertebral wedging and is diagnosed using lateral radiographs of the spine. The thoracic spine is most often affected, but Scheuermann's disease may also involve the lumbar spine. Lumbar Scheuermann's disease affects the T10-L4 vertebrae. Blumenthal et al. [1] classified lumbar Scheuermann's disease into two main forms. The signs of the first, or the "classic," form of Scheuermann's disease are the 5° wedging of at least three vertebrae, central Schmorl's nodes, and endplate irregularities, but no disk-space narrowing. The signs of the second major type, the "atypical" form, are endplate irregularities in only one or two vertebrae, anterior Schmorl's nodes, and disk-space narrowing, but no anterior wedging of the vertebral bodies. Blumenthal et al. also described another type of atypical lumbar Scheuermann's disease that they termed "acute traumatic intraosseous disc [sic] herniation," a condition in which a past acute vertical compression injury results in severe back pain and in which evidence of endplate fracture is observed [1].

We encountered atypical lumbar Scheuermann's disease in 12-year-old identical twin girls. One of the patients was asymptomatic and without deformity. Scheuermann's disease was discovered only because she underwent radiography (Figs. 2 and 3).

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2. —Lateral radiograph of lumbar spine obtained in standing symptomatic 12-year-old girl, one of identical twins with atypical lumbar Scheuermann's disease, reveals irregular endplates of L2 and L3 vertebrae, disk space narrowing between L1 and L2 and between L2 and L3 vertebrae, and anterior Schmorl's nodes. Patient was asymptomatic and without deformity.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3. —Lateral radiograph of lumbar spine obtained in standing asymptomatic 12-year-old girl, second of identical twins with atypical lumbar Scheuermann's disease, reveals endplate irregularity, anterior Schmorl's nodes, and disk space narrowing between L2 and L3 vertebrae.

Numerous theories have been suggested regarding the etiology and pathophysiology of Scheuermann's disease [2]. Although the role of inheritance has not been emphasized in the literature, familial clustering has been reported in thoracic Scheuermann's disease [3], and atypical lumbar Scheuermann's disease has been previously reported in identical twins [4]. Clearly, genetic factors are among the many contributing to the development of Scheuermann's disease. Because those with the disease may have no symptoms or deformities, radiographic screening of the apparently healthy family members of patients with confirmed cases of Scheuermann's disease should be performed. Such data may clarify the role of genetic factors in Scheuermann's disease.

References

1. Blumenthal SL, Roach J, Herring JA. Lumbar Scheuermann's: a clinical classification. Spine 1987;12:929 -932[Medline]
2. Lowe TG. Scheuermann disease. J Bone Joint Surg Am 1990;72:940 -945[Free Full Text]
3. McKenzie L, Sillence D. Familial Scheuermann's disease: a genetic and linkage study. J Med Genet 1992;29:41 -45[Abstract/Free Full Text]
4. Bjersand AJ. Juvenile kyphosis in identical twins. AJR 1980;134:598 -599[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gustavel, M. Articles by Beals, R. K. Search for Related Content PubMed PubMed Citation Articles by Gustavel, M. Articles by Beals, R. K. Social Bookmarking                      What's this?