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Minimum five-year follow-up of posterior-only pedicle screw constructs for thoracic and thoracolumbar kyphosis

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Abstract

Study design

Retrospective cohort study.

Objective

To review/report 5-year follow-up data on patients diagnosed with thoracic and thoracolumbar kyphosis (TK/TLK) treated with posterior-only spinal fusion.

Summary of background data

TK/TLK was initially treated with combined anterior/posterior spinal fusion, evolving into widespread treatment with posterior-only spinal fusion.

Methods

Forty-three patients who underwent a posterior-only spinal fusion for a primary diagnosis of TK/TLK from 1999 to 2009 with > 5-year follow-up were identified. Preoperative/postoperative/final follow-up measurements were recorded from full-length standing radiographs. Prospectively collected outcome scores were reviewed for the same time points, and charts were examined for complications.

Results

Patient age averaged 33 years (range 13–77), and follow-up averaged 5.6 years (range 5–12.2). Diagnoses included Scheuermann’s disease (N = 15, 35%), idiopathic (N = 10, 23%), pseudarthrosis (N = 6, 14%), iatrogenic (N = 4, 9%), degenerative (N = 3, 7%), post-traumatic (N = 3, 7%), and congenital kyphosis (N = 2, 5%). Average correction of 44.3° (46%; 92.8° preoperatively vs 48.5° postoperatively) was achieved through posterior-only surgery. Loss of correction averaged only 1° in the instrumented segments at final follow-up. Eleven patients had a complication; proximal junctional kyphosis was the most common (N = 3, 7%). One patient lost intraoperative monitoring and one had temporary neurological deterioration postoperatively, but there was no permanent deficit. No pseudarthroses occurred. ODI scores improved 17.2 points on average (p = 0.01). SRS scores improved in all domains (average 0.79, p < 0.001).

Conclusion

Pedicle screw constructs permit effective posterior-only correction of TK/TLK that is maintained at the 5-year follow-up time point. Patients report improvement, via outcome questionnaires, at the same follow-up time points.

Graphic abstract

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Funding

None of the authors received financial support in relation to this manuscript. Washington University Department of Orthopedic Surgery Spine Service receives grant monies from Axial Biotech, the Setting Scoliosis Straight Foundation and DePuy Spine. Dr. Lenke shares numerous patents with Medtronic (unpaid). He receives substantial royalties from Medtronic and modest royalties from Quality Medical Publishing. Dr. Lenke also receives or has received reimbursement related to meetings/courses from AMCICO, AOSpine, COA, BroadWater, DePuy, Dubai Spine Society, Medtronic, SDSG, SOSORT, The Spinal Research Foundation, SRS, SSF.

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Authors and Affiliations

  1. Scoliosis Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Chang Ju Hwang

  2. Department of Orthopedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian/Allen, Columbia University, 5141 Broadway, New York, NY, 10034, USA

    Lawrence G. Lenke & Kathy M. Blanke

  3. Spinal Deformity Service, Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Michael P. Kelly & Brenda A. Sides

  4. Spine Surgery and Complex Spinal Reconstruction, Massachusetts General Hospital, Boston, MA, USA

    Stuart Hershman

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  1. Chang Ju Hwang
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  2. Lawrence G. Lenke
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  3. Michael P. Kelly
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  4. Brenda A. Sides
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  5. Kathy M. Blanke
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  6. Stuart Hershman
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Correspondence to Lawrence G. Lenke.

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Hwang, C.J., Lenke, L.G., Kelly, M.P. et al. Minimum five-year follow-up of posterior-only pedicle screw constructs for thoracic and thoracolumbar kyphosis. Eur Spine J 28, 2609–2618 (2019). https://doi.org/10.1007/s00586-019-06076-0

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  • DOI: https://doi.org/10.1007/s00586-019-06076-0

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