The radiological reporting of lumbar Scheuermann's disease: an unnecessary source of confusion amongst clinicians and patients

Abstract

Patients with mechanical lower back pain not uncommonly present to clinicians with anxiety following a diagnosis of "Scheuermann's disease" based on a report of a plain radiograph of the lumbar spine. In most instances, the radiographs show features of lumbar Scheuermann's, rather than the classical adolescent thoracic kyphosis described by Scheuermann in 1920. The purpose of this study was (i) to investigate how often the diagnosis of Scheuermann's disease was made at a District General Hospital in radiological reports sent to local general practitioners (GPs); (ii) to determine the type of "Scheuermann's disease" being described; and (iii) to assess what GPs understood by the term "Scheuermann's disease" in the context of a specific clinical presentation. 50 reports were identified in a computerized search for diagnoses of "Scheuermann's disease". Review of the radiographs revealed that 80% showed features of lumbar Scheuermann's disease and 20% classical Scheuermann's. A questionnaire was issued to local GPs that described a case history of an adult patient with typical mechanical lower back pain for whom a radiological report, describing degenerative changes in the lumbar spine, concluded that some of the features "were consistent with Scheuermann's disease". 86% of GPs stated that they would inform their patients that they had "Scheuermann's disease" (using that exact term), but only 51% understood the meaning of the diagnosis in the context of the case history. We recommend that the term "Scheuermann's disease" be avoided in radiological reports to GPs and other non-specialist clinicians except when reporting on classical adolescent thoracic kyphosis.