Scheuermann's juvenile kyphosis.

OBJECTIVE: Two cases are discussed to illustrate two different presentations, progressions and treatments of Scheuermann's juvenile kyphosis. CLINICAL FEATURES: In one case, a 13-yr-old boy suffered from a 2-yr history of lower back pain. Radiographs demonstrated irregularity of the upper lumbar vertebral endplates, associated with Schmorl's nodes. The second case is one of a 14-yr-old boy who was seen in an orthopedic outpatient clinic. Radiographs revealed wedging of the anterior border of T6, T7, and T8 vertebrae with a thoracic spine kyphotic deformity measuring 72 degrees. INTERVENTION AND OUTCOME: The first case was treated conservatively. The patient maintained his improvement at 6 month follow-up. The second case was initially treated with a brace that the patient did not wear regularly as directed. The kyphotic deformity progressed from 72 degrees to 92 degrees. An operation was performed to reduce the kyphotic curve and prevent further progression. On review 6 yr later, the patient was well without back pain or other complications. The kyphotic curve measured 65 degrees. CONCLUSION: Scheuermann's juvenile kyphosis is a common spinal deformity in the adolescent. A radiographic appearance of wedging of the anterior portion of the vertebral bodies with marked kyphotic deformity suggests the diagnosis of classical Scheuermann's disease. However, the lumbar type of Scheuermann's disease should be considered in young patient with radiographic evidence of irregular vertebral endplates, Schmorl's nodes and a decreased disc space without wedging. Nevertheless, significant progression of the curve in both the typical and atypical types of Scheuermann's disease is rare, but can occur. An algorithm is presented to facilitate decision making in the management of Scheuermann's juvenile kyphosis.

Destructive arthritis of the hip in a patient with Crohn's disease.

OBJECTIVE: Isolated destructive peripheral arthropathy is a rare complication of Crohn's disease. We describe the clinical course and radiographic findings of such a case. CLINICAL FEATURES: A 28-yr-old male presented to our chiropractic clinic with chronic left hip pain. The patient was known to have Crohn's disease. Five years earlier the gastrointestinal symptoms resolved with a brief course of prednisone. However, the left hip pain continued. A radiograph of the left hip was read as normal. Repeat radiograph, 2 yr later, revealed destructive changes of the left hip and, in retrospect, early destructive changes could be seen on the initial radiograph. INTERVENTION AND OUTCOME: The diagnosis, in this case, was destructive arthritis of the left hip secondary to Crohn's disease. The treatment selected in this case was observation and nonsteroidal anti-inflammatory drug use. CONCLUSION: This diagnosis, a relatively rare complication of Crohn's disease, should be considered in a young adult patient with Crohn's disease and persistent peripheral joint pain.

Sacroiliac joint dysfunction and low back pain in school aged children.

Back pain is known to be very common in adults, but the prevalence in children is unknown. Furthermore, the prevalence of sacroiliac dysfunction, and its relationship to back pain has not been previously studied. In this study, we found a high percentage of school aged children had sacroiliac dysfunction and low-back pain.