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Posterior-only versus combined anterior/posterior fusion in Scheuermann disease: a large retrospective study

  • Guillaume Riouallon
  • Christian Morin
  • Yann-Philippe Charles
  • Pierre Roussouly
  • Gaby Kreichati
  • Ibrahim Obeid
  • Stéphane Wolff
  • French Scoliosis Study Group
Original Article

Abstract

Purpose

The literature shows controversies concerning surgical treatment of Scheuermann’s kyphosis between posterior-only fixation and combined anterior/posterior fusion. The aim of this study is to compare the clinical and radiological results and the rate of complications between these two techniques.

Methods

We performed a multicentric retrospective review of 131 patients who underwent primary fusion for Scheuermann’s kyphosis divided into two groups: 67 patients operated via posterior approach only and 64 operated via combined anterior/posterior approach.

Classical clinical, surgical and radiological data were collected. A descriptive and statistical analysis was performed between the two groups to evaluate the influence of the surgical procedure on the rate of complications, the functional results and radiological correction.

Results

The average age was 23 and the average kyphosis was 77 degrees. The mean follow-up was 4.2 years (range 0.1–27.3). There was no difference regarding demographic data, preoperative radiographic data and length of fusion between the two groups. Functional results were good in 81% of cases. Kyphosis correction was on average 15° and the correction of the compensatory lumbar lordosis was 20°. The correction was stable at final follow-up. There was no difference between the two groups in terms of functional results, the complications rate and radiological correction.

Conclusion

Surgery for Scheuermann’s kyphosis gives good and stable functional and radiological results. Given the fact that the two surgical strategies give the same results, it appears that the anterior/posterior fusion technique to treat Scheuermann’s kyphosis should be reserved for major deformations.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Scheuermann’s kyphosis Sagittal balance Anterior/posterior spinal fusion Posterior spinal fusion 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

586_2018_5633_MOESM1_ESM.pptx (627 kb)
Supplementary material 1 (PPTX 626 kb)

References

  1. 1.
    Palazzo C, Sailhan F, Revel M (2014) Scheuermann’s disease: an update. Jt Bone Spine Rev Rhum 81(3):209–214CrossRefGoogle Scholar
  2. 2.
    Papagelopoulos PJ, Klassen RA, Peterson HA, Dekutoski MB (2001) Surgical treatment of Scheuermann’s disease with segmental compression instrumentation. Clin Orthop 386:139–149CrossRefGoogle Scholar
  3. 3.
    Hosman AJ, Langeloo DD, de Kleuver M, Anderson PG, Veth RP, Slot GH (2002) Analysis of the sagittal plane after surgical management for Scheuermann’s disease: a view on overcorrection and the use of an anterior release. Spine 27(2):167–175CrossRefPubMedGoogle Scholar
  4. 4.
    Lim M, Green DW, Billinghurst JE, Huang RC, Rawlins BA, Widmann RF et al (2004) Scheuermann kyphosis: safe and effective surgical treatment using multisegmental instrumentation. Spine 29(16):1789–1794CrossRefPubMedGoogle Scholar
  5. 5.
    Johnston CE, Elerson E, Dagher G (2005) Correction of adolescent hyperkyphosis with posterior-only threaded rod compression instrumentation: is anterior spinal fusion still necessary? Spine 30(13):1528–1534CrossRefPubMedGoogle Scholar
  6. 6.
    Lee SS, Lenke LG, Kuklo TR, Valenté L, Bridwell KH, Sides B et al (2006) Comparison of Scheuermann kyphosis correction by posterior-only thoracic pedicle screw fixation versus combined anterior/posterior fusion. Spine 31(20):2316–2321CrossRefPubMedGoogle Scholar
  7. 7.
    Lonner BS, Newton P, Betz R, Scharf C, O’Brien M, Sponseller P et al (2007) Operative management of Scheuermann’s kyphosis in 78 patients: radiographic outcomes, complications, and technique. Spine. 32(24):2644–2652CrossRefPubMedGoogle Scholar
  8. 8.
    Koptan WMT, Elmiligui YH, Elsebaie HB (2009) All pedicle screw instrumentation for Scheuermann’s kyphosis correction: is it worth it? Spine J Off J North Am Spine Soc. 9(4):296–302CrossRefGoogle Scholar
  9. 9.
    Denis F, Sun EC, Winter RB (2009) Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spin. 34(20):E729–E734CrossRefGoogle Scholar
  10. 10.
    Koller H, Juliane Z, Umstaetter M, Meier O, Schmidt R, Hitzl W (2014) Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 23(1):180–191CrossRefGoogle Scholar
  11. 11.
    Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C (2005) Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine 30(14):1643–1649CrossRefPubMedGoogle Scholar
  12. 12.
    Bradford DS, Moe JH, Montalvo FJ, Winter RB (1975) Scheuermann’s kyphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients. J Bone Joint Surg Am 57(4):439–448CrossRefPubMedGoogle Scholar
  13. 13.
    Behrbalk E, Uri O, Parks RM, Grevitt MP, Rickert M, Boszczyk BM (2014) Posterior-only correction of Scheuermann kyphosis using pedicle screws: economical optimization through screw density reduction. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 23(10):2203–2210CrossRefGoogle Scholar
  14. 14.
    Herndon WA, Emans JB, Micheli LJ, Hall JE (1981) Combined anterior and posterior fusion for Scheuermann’s kyphosis. Spine 6(2):125–130CrossRefPubMedGoogle Scholar
  15. 15.
    Koller H, Lenke LG, Meier O, Zenner J, Umschlaeger M, Hempfing A et al (2015) Comparison of anteroposterior to posterior-only correction of Scheuermann’s kyphosis: a matched-pair radiographic analysis of 92 patients. Spine Deform 3(2):192–198CrossRefPubMedGoogle Scholar
  16. 16.
    Speck GR, Chopin DC (1986) The surgical treatment of Scheuermann’s kyphosis. J Bone Joint Surg Br 68(2):189–193CrossRefPubMedGoogle Scholar
  17. 17.
    de Jonge T, Illés T, Bellyei A (2001) Surgical correction of Scheuermann’s kyphosis. Int Orthop 25(2):70–73CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Metz-Stavenhagen P, Ferraris L, Krebs S, Hempfing A (2006) P70. Scheuermann’s kyphosis—Single posterior approach or anterior release and posterior instrumentation? Spine J 6:1S–161SCrossRefGoogle Scholar
  19. 19.
    Coe JD, Smith JS, Berven S, Arlet V, Donaldson W, Hanson D et al (2010) Complications of spinal fusion for scheuermann kyphosis: a report of the scoliosis research society morbidity and mortality committee. Spine 35(1):99–103CrossRefPubMedGoogle Scholar
  20. 20.
    Tsutsui S, Pawelek JB, Bastrom TP, Shah SA, Newton PO (2011) Do discs “open” anteriorly with posterior-only correction of Scheuermann’s kyphosis? Spine 36(16):E1086–E1092CrossRefPubMedGoogle Scholar
  21. 21.
    Etemadifar M, Ebrahimzadeh A, Hadi A, Feizi M (2016) Comparison of Scheuermann’s kyphosis correction by combined anterior-posterior fusion versus posterior-only procedure. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 25(8):2580–2586CrossRefGoogle Scholar
  22. 22.
    A new technique to prevent proximal junctional kyphosis in the surgical treatment of Scheuermann disease. IMAST; 2009; ViennaGoogle Scholar
  23. 23.
    Nasto LA, Perez-Romera AB, Shalabi ST, Quraishi NA, Mehdian H (2016) Correlation between preoperative spinopelvic alignment and risk of proximal junctional kyphosis after posterior-only surgical correction of Scheuermann kyphosis. Spine J Off J North Am Spine Soc 16(4 Suppl):S26–S33CrossRefGoogle Scholar
  24. 24.
    Lowe TG (1987) Double L-rod instrumentation in the treatment of severe kyphosis secondary to Scheuermann’s disease. Spine 12(4):336–341CrossRefPubMedGoogle Scholar
  25. 25.
    Lowe TG, Kasten MD (1994) An analysis of sagittal curves and balance after Cotrel–Dubousset instrumentation for kyphosis secondary to Scheuermann’s disease. A review of 32 patients. Spine 19(15):1680–1685CrossRefPubMedGoogle Scholar
  26. 26.
    Lowe TG (1999) Scheuermann’s disease. Orthop Clin North Am 30(3):475–487CrossRefPubMedGoogle Scholar
  27. 27.
    Poolman RW, Been HD, Ubags LH (2002) Clinical outcome and radiographic results after operative treatment of Scheuermann’s disease. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 11(6):561–569CrossRefGoogle Scholar
  28. 28.
    Herrera-Soto JA, Parikh SN, Al-Sayyad MJ, Crawford AH (2005) Experience with combined video-assisted thoracoscopic surgery (VATS) anterior spinal release and posterior spinal fusion in Scheuermann’s kyphosis. Spine 30(19):2176–2181CrossRefPubMedGoogle Scholar
  29. 29.
    Otsuka NY, Hall JE, Mah JY (1990) Posterior fusion for Scheuermann’s kyphosis. Clin Orthop 251:134–139Google Scholar
  30. 30.
    Arlet V, Schlenzka D (2005) Scheuermann’s kyphosis: surgical management. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 14(9):817–827CrossRefGoogle Scholar
  31. 31.
    Ning Y, Lenke L, Bridwell K, Koester L (2011) How to determine optimal fusion levels of Scheuermann’s kyphosis. In: SRS annual meeting, LouisvilleGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Groupe Hospitalier Paris Saint-JosephParisFrance
  2. 2.Hopale/Institut CalotBerck/MerFrance
  3. 3.Service de Chirurgie Orthopédique du Rachis et de Traumatologie du SportHôpital Civil, Pavillon Chirurgical BStrasbourg CedexFrance
  4. 4.Des Massues Surgical CenterLyonFrance
  5. 5.Hôpital Hôtel-Dieu de France, Université Saint-JosephBeyrouthLebanon
  6. 6.Centre Hospitalier Universitaire de BordeauxBordeauxFrance

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