Thoracolumbar disc herniation in Scheuermann's disease: distinct clinical characteristics in elderly and adolescent patients.

BACKGROUND

Scheuermann's disease always occurs in adolescent, and it is uncommon for elderly individuals. The aim of this research is to investigate the different potential pathogenic mechanisms and clinical characteristics of thoracolumbar disc herniation (TLDH) in Scheuermann's disease between elderly and adolescent patients.

METHODS

We retrospectively analyzed data from patients with Scheuermann's disease who underwent surgical treatment for TLDH from a single center between June 2013 and June 2023. Patients were divided into two groups: elderly (≥ 65 years) and adolescent (≤ 20 years), with 24 patients in each group. Data, including medical records and imaging parameters, were independently collected and analyzed by two doctors.

RESULTS

The elderly group exhibited significantly lower preoperative modified Japanese Orthopaedic Association (mJOA) scores (5.58 ± 2.38 vs. 7.25 ± 2.19, P = 0.009) and longer symptom duration (48.29 ± 62.32 vs. 8.37 ± 13.19 months, P < 0.001) compared to the adolescent group. The elderly group also had a higher prevalence of diabetes mellitus (6/24 vs. 0/24, P = 0.029), fewer Schmorl's nodes, more severe intervertebral disc degeneration, and a higher frequency of intervertebral disc vacuum phenomena. Additionally, elderly patients exhibited more frequent localized ossification or hypertrophy of the ligamentum flavum in the thoracolumbar region.

CONCLUSION

The later onset of TLDH in Scheuermann's disease among elderly patients is likely due to a combination of genetically determined higher endplate strength and age-related degenerative factors. Elderly patients also commonly show localized ossification or hypertrophy of the ligamentum flavum, which may contribute to more severe symptoms.