Juvenile Disc Disorder

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:

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  • Medications
  • Chiropractic or osteopathic manipulations
  • Epidural injections
  • TENS units
  • Physical therapy (exercises, stretching)

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.

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Dr. Paul McAfee, Orthopedic Surgeon, Towson, MD, 21204
Article written by: Paul C. McAfee, MD