Enfermedad de Scheuermann: tratamiento, causas, síntomas, diagnóstico y prevención

La enfermedad de Scheuermann (cifosis juvenil) se define como un aumento anormal de la cifosis dorsal (normal hasta 20-40°) durante la pubertad, con al menos 5 grados de acuñamiento anterior de un mínimo de tres o más vértebras adyacentes. Es diferente de la sobrecarga de hombros postural, que es más flexible y no se asocia a signos radiográficos vertebrales.67 Aunque la etiología es incierta, en el 30-48 % de los casos se advierte una incidencia familiar. Afecta al 1 % de la población y es más frecuente en los varones.

Clínicamente pueden distinguirse dos formas de cifosis juvenil. Mientras la enfermedad de Scheuermann dorsal tiene el vértice de la curva en D7-D9, la enfermedad de Scheuermann dorsolumbar tiene el vértice en D11-D12. Con frecuencia la queja principal es la deformidad estética. El dolor suele ser persistente y es más frecuente en la forma toracodorsal.68

Las radiografías deben incluir las proyecciones postero-anterior y lateral en bipedestación. Las proyecciones laterales en hiperextensión ayudan a determinar la flexibilidad de la curva. Las radiografías muestran irregularidad de las placas terminales de las vértebras, acuñamiento anterior de

5 grados o superior en tres o más vértebras adyacentes, nódulos de Schmorl y un aumento de la cifosis entre D4 y D12 medida con el método de Cobb.

La cifosis puede empeorar durante el período de crecimiento. Las curvas de 40 a 60 grados pueden tratarse mediante un conjunto de ejercicios de hiperextensión si la curva es flexible y se comprueba que se corrige activamente. Las curvas de más de 60-75 grados se tratan con un corsé de Milwaukee o con una ortesis axilar con placa torácica. Se comienza con el corsé si las placas terminales de las vértebras no están aún fusionadas al cuerpo vertebral, llevándolo ininterrumpidamente durante 6-12 meses, para después hacerlo a tiempo parcial (unas 16 horas/día) durante 6 meses o hasta que las placas terminales se fusionen. El corsé es menos eficaz para las curvas mayores de 65-75 grados o después de la maduración del esqueleto. La cirugía puede estar indicada por razones estéticas, progresión de la deformidad a pesar del corsé o dolor insoportable. No se han identificado trastornos cardiopulmonares a largo plazo.69,70

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