Scheuermann’s disease is defined as a structural and often painful hyperkyphosis, more or less reducible, associated with irregularities of the vertebral endplates and deformities of the vertebral bodies [1]. It most commonly affects the thoracic spine, although thoracolumbar and lumbar involvement may also occur [2]. The condition affects approximately 0.4% to 10% of adolescents, typically between 10 and 14 years of age, with a predominance in males [1,3]. However, recent studies suggest a more balanced sex distribution and a potentially underestimated prevalence due to pauci-symptomatic forms [7,8].

The exact etiology remains unclear [2]. Several pathophysiological mechanisms have been proposed, likely reflecting the combined effects of mechanical, metabolic, muscular, and genetic factors [2–4]. Recent studies have highlighted abnormalities in endochondral ossification of the vertebral endplates, leading to impaired vertebral growth and the characteristic anterior wedging [7]. Furthermore, morphologic studies have demonstrated structural alterations of the vertebral endplates and intervertebral discs, supporting the hypothesis of an early degenerative process [8].

The most common presenting features are thoracic kyphosis and back pain [5]. The pain is typically mechanical in nature, progressively worsening throughout the day and exacerbated by prolonged sitting and physical activity [6]. Some studies suggest that pain may be more pronounced in patients with more severe deformities, with variable functional impact [8].

Clinical examination should focus on two key features: segmental spinal stiffness, often painful, and sagittal imbalance. Stiffening of the hyperkyphotic segment leads to compensatory hyperlordosis of the lumbar and cervical spine [6]. Sagittal imbalance may also be observed depending on the severity of the deformity [7].

Imaging plays a central role in diagnosis, allowing confirmation of the disease, assessment of lesion extent and severity, evaluation of sagittal alignment, and exclusion of differential diagnoses [1]. Standard spinal radiographs, ideally obtained in anteroposterior and lateral views of the entire spine, constitute the first-line imaging modality [6].

Measurement of the Cobb angle is essential to quantify the degree of kyphosis, with normal values ranging from 25° to 45° [4]. The radiological diagnosis of Scheuermann’s kyphosis is based on Sörensen’s criteria, which include anterior vertebral wedging greater than 5° in at least three consecutive vertebrae at the apex of the deformity, irregular and flattened vertebral endplates, narrowing of intervertebral disc spaces, and the presence of Schmorl’s nodes [5]. These findings reflect structural alterations of the vertebral bodies and intervertebral discs, as described in recent radiological morphology studies [8]. Less commonly, additional findings such as a beveled appearance, notching, or marginal avulsion (limbus vertebra) may be observed [1].

Magnetic Resonance Imaging (MRI) is a complementary modality that is particularly valuable in atypical thoracolumbar or lumbar forms. Based on the same Sörensen criteria, MRI allows confirmation of the diagnosis, evaluation of intervertebral disc hydration, and detection of inflammatory changes such as vertebral endplate bone marrow edema [6]. It also provides a more detailed assessment of disc structures and bone marrow changes, reinforcing its role in complex or atypical cases [7,8].

In addition to spinal stiffness and progression of deformity into adulthood, rare but potentially severe complications may occur, particularly neurological complications secondary to spinal cord compression, which may present as spastic paraparesis or lumbar spinal canal stenosis [6]. In severe cases, restrictive respiratory impairment may also develop due to thoracic deformity [8]. In such situations, MRI, including diffusion-weighted imaging and apparent diffusion coefficient analysis, plays a crucial role in diagnostic evaluation [4].

Management of Scheuermann’s disease is primarily conservative, with surgery reserved for severe cases. Mild forms are managed with clinical monitoring and lifestyle modifications [1]. Functional treatment is indicated in both postural and structural kyphosis and includes physiotherapy focusing on postural correction, muscle stretching, and strengthening of the abdominal and paravertebral musculature [6]. Orthopedic management, mainly based on bracing, is indicated in painful or progressive forms or in cases of failure of rehabilitation [1,6]. Surgical treatment is reserved for severe kyphosis, particularly in patients at risk of progression beyond skeletal maturity, or in those presenting with significant aesthetic deformity, chronic pain, or, more rarely, neurological complications [6].