Radiological Signs of Scheuermann Disease and Low Back Pain: Retrospective Categorization of 188 Hospital Staff Members With 6-Year Follow-up

Low back pain (LBP) is a leading debilitating disorder worldwide,1 affecting up to 84% of the general population at some point in life.2 It not only impacts patients' quality of life and financial well-being, but also the financial health of the entire health care system.3 The majority of LBP is nonspecific, with no sign of a specific spinal disorder or definite underlying condition such as cancer or infection, posing difficulty for its prevention and treatment.4 Potential LBP risk factors include physiological factors (female sex,5,6 obesity,2,7 and poor health8), socioeconomic factors (smoking,2,9 heavy workload,2,6,8 and low income10), and psychological factors (work dissatisfaction10 and depression11). However, the majority of these risk factors concern outside influences that are inherently difficult to assess in an individual clinical encounter. Among intrinsic factors, some are too subtle (e.g., sex) for use in the spinal community, whereas others are too subtle (e.g., interleukin-1 gene cluster polymorphism2) for accessibility in typical clinical settings. Magnetic resonance (MR) of the spine can provide straightforward information on disc degeneration (DD). However, current evidence on the association between DD and LBP in adult populations is generally not strong and has been controversial.2,12,13 Therefore, identifying new intrinsic risk factors of LBP that are both straightforward and acquirable in daily practice is significant to LBP investigation and management. 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 ​(Figure1;1; Table ​Table11). 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 ... TABLE 1. Description of 15 Reports on the Diagnostic Criteria of Atypical (Lumbar) SD Notably, both classic SD and atypical SD are associated with back pain.14,16,17,19–22 Although Scheuermann kyphosis is uncommon, SD radiological signs have been observed in 18% to 40% of the general population,23 suggesting that SD, or more precisely, “SD-like” spine, may be a variant of normal spine morphology rather than a disease. A genetic role in the cause of SD has been proposed, with a suspected autosomal dominant pattern of inheritance.20,24 The Trp3 allele, a variant of the COL9A3 gene, has been associated with SD.20 We speculated whether an SD-like spine is associated with LBP in the general population. However, previous studies on the relationship between SD and LBP have primarily focused on patients with Scheuermann kyphosis, back pain, or sciatica. Therefore, we conducted this study to investigate the relationship between SD-like spines and LBP in a local population of hospital staff members.