Juvenile disc disorder
Juvenile disc disorder, or juvenile discogenic disorder,
represents a condition where the endplates of the disc
spaces are not strong enough to withstand the pressures
generated within the disc spaces. This leads to disc
herniations into the vertebral bodies (called Schmorl’s
nodes) and causes back pain at an early age.
This condition is sometimes referred to as Scheuermann’s
disease, or Lumbar Scheuermann’s disease,
but the preferred medical terminology for this condition
is juvenile disc disorder.
Juvenile disc disorder is not as common as Scheuermann’s
kyphosis and is not associated with deformity of the
spine. Patients with juvenile disc disorder usually
have lower back pain that is made worse with bending
forward and activity, and feels better with rest.
This condition is very much like degenerative disc
disease in the adult population, but the degeneration
starts at a much earlier age, and usually involves most
of the discs of the lumbar spine (as opposed to only
one or two discs typically involved in degenerative
disc disease).
Treatments for juvenile disc disorder
Conservative (non-surgical) treatments for juvenile
disc disorder are largely the same as for adult degenerative
disc disease, and surgery to fuse a segment is rarely
advisable.
Conservative treatments may include one or a combination
of the following:
It is important to note that adolescents who have back
pain due to juvenile disc disorder do not need to have
their activities medically restricted. In fact, physical
activity is encouraged as it can help keep the back
strong and healthy. In general, adolescents who are
inactive have a higher rate of back pain as they become
deconditioned and weaker.
There is no conclusive evidence that activity accelerates
the disc degeneration, so adolescents with this diagnosis
should be allowed to participate in athletics as their
pain allows. A well-balanced exercise program of daily
hamstring stretching, strength training, and aerobic
conditioning is best.
Because the degeneration typically occurs in multiple
discs, any attempt to fuse one or more levels of the
lumbar spine will place a lot more pressure on the already
weakened other levels. Fusing the whole spine leads
to only more pain as the spine is basically meant to
move, and attempts at fusing the whole lumbar spine
are rarely successful in reducing pain.
However, surgery to remove a disc herniation that is
compressing a nerve is reasonable, as a decompression
surgery (e.g. microdiscectomy) can relieve pain but
does not change the natural biomechanics of the spine.
Vocationally, patients with a lot of back pain and
evidence of juvenile disc disorder on their imaging
studies should be counseled to not consider a heavy
manual labor job. Even though manual labor may not accelerate
the degeneration, if they use their back for a living
but are prone to bouts of low back pain, then they may
have a lot of difficulty performing their jobs satisfactorily.
In general, people are able to perform a more sedentary
job whether or not low back pain is present.
By:
Paul C. McAfee, MD
December 2, 2002
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