Magnetic resonance imaging findings of the lumbar spine, back symptoms and physical function among male adult patients with Scheuermann's disease

Leena Ristolainen; Jyrki A Kettunen; Heidi Danielson; Markku Heliövaara; Dietrich Schlenzka

doi:10.1016/j.jor.2020.02.004

Magnetic resonance imaging findings of the lumbar spine, back symptoms and physical function among male adult patients with Scheuermann's disease

J Orthop. 2020 Feb 4:21:69-74. doi: 10.1016/j.jor.2020.02.004. eCollection 2020 Sep-Oct.

Authors

Leena Ristolainen¹, Jyrki A Kettunen², Heidi Danielson¹, Markku Heliövaara³, Dietrich Schlenzka⁴

Affiliations

¹ Orton Orthopaedic Hospital, Helsinki, Finland, Tenholantie 10, PL 29, 00281, Helsinki, Finland.
² Arcada, University of Applied Sciences, Jan-Magnus Janssonin aukio 1, 00560, Helsinki, Finland.
³ National Institute for Health and Welfare, Helsinki, Finland, Mannerheimintie 166, PL 30, 00271, Helsinki, Finland.
⁴ Research Institute Orton, Helsinki, Finland, Tenholantie 10, PL 29, 00281, Helsinki, Finland.

Abstract

Background: There are only a few studies on untreated Scheuermann's disease and magnetic resonance imaging (MRI) findings in the lumbar spine. The primary aim of this study was to clarify lumbar MRI findings in patients with Scheuermann's disease and to compare with subjects without diagnosed spine disease.

Methods: Twenty-two male adult Scheuermann's patients (mean age 64.7 years (Standard Deviation [SD] 6.4) and 26 males (mean age 59.7 years [SD 7.4]) from a national health survey were included in this study. From MR images, the dimensions of the vertebral bodies, intervertebral discs and the dural sac were measured. Spondylolisthesis, Modic changes (MC), high intensity zone values (HIZ), and Schmorl's nodes were registered from both groups as well as self-reported data concerning general health, quality of life, and back pain symptoms.

Results: Significantly more patients with Scheuermann's disease had at least one MC compared to the controls at the level L1/L2 (Odds Ratio [OR] 21.11, 95% Confidence Interval [95% CI] 2.31-192.96), at the level L3/L4 (OR 13.62, 95% CI 1.41-131.26), and at the level L5/S1 (OR 6.11, 95% CI 1.50-24.83). Patients had significantly more Schmorl's nodes compared to the controls (64% vs. 8%, p < 0.001). The area of the dura sac (L3/L4) was larger (mean 201 mm² vs. 152 mm², p = 0.017) in the patients compared to controls. At level L1/L2 patients had higher disc than controls (mean 7.9 mm vs. 6.8 mm, p = 0.038). After adjusting for age patients had more commonly constant back pain (OR 9.4, 95% CI 1.56-56.97), and difficulties in walking up one floor without resting (OR 9.8, 95% CI 1.01-95.34) than controls.

Conclusions: Schmorl's nodes and Modic changes on lumbar MRI, back pain and physical function restrictions seem to be more prevalent among patients with Scheuermann's disease than in the general population.

Keywords: Low back pain; Lumbar MRI; Scheuermann's disease.