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Comparison of Scheuermann’s kyphosis correction by combined anterior–posterior fusion versus posterior-only procedure

European Spine Journal volume 25, pages 2580–2586 (2016)Cite this article

Abstract

Introduction

Conventional treatment of rigid deformity in Scheuermann’s kyphosis (SK) in young patients includes a preliminary anterior spinal release and fusion (ASF) followed by posterior spinal fusion and instrumentation (PSF). However, recently there are more trends to do posterior-only surgery for correction of this deformity. The aim of our study was to compare clinical and radiological outcomes of ASF/PSF and PSF-only procedures in treatment of SK.

Materials and methods

In a prospective clinical and radiological review, thirty operated SK patients in two groups were evaluated. Group A: ASF/PSF technique (n: 16) and group B: PSF-only procedure (n: 14) were followed for at least 2 years (average 57.6 months). Two groups were well matched for the following four criteria: average age, flexibility status, posterior fusion levels, and preoperative Cobb’s kyphosis angle. Oswestry disability index (ODI) and scoliosis research society questionnaire-30 (SRS-30) and radiological (kyphosis correction, correction loss, sagittal balance) parameters were evaluated before and after surgery and at the final follow-up.

Results

In group A, primary thoracic Cobb’s kyphosis, immediate post-operative kyphosis, and final follow-up kyphosis angle were 83.6°, 41.4° and 43°, respectively (P < 0.05). Correction rate and correction loss were 50.5 % and 1.6° ± 2.4, respectively. In group B, the corresponding values were 81.9°, 40.1° and 43.2°, respectively (P < 0.05). Correction rate and correction loss were 51 % and 3.1° ± 2.5, respectively. SRS-30 and ODI scores in group A were averaged 68.5 and 21.3 preoperatively and 128.7 and 6.25 at the final follow-up, respectively. In group B, the corresponding values were 64 and 23.2 preoperatively and 133.5 and 5.8 at the final follow-up, respectively.

Conclusions

Clinical and radiological parameters were similar in both groups after surgical correction while, complication rates, operation time and blood loss were significantly higher in ASF/PSF procedure.

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References

  1. Scheuermann’s Sorensen KH (1964) Juvenile Kyphosis. Enjar Munkesgaard Forlag, Copenhagen, pp 214–222

    Google Scholar 

  2. Bradford DS, Moe JH, Montalvo FJ et al (1975) Scheuermann’s Khphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients. J Bone Jt Surg 57:439–448

    CAS  Google Scholar 

  3. Bradford DS, Ahmad KB, Moe JH et al (1980) The surgical management of scheuermann’s disease : a review of twenty-four cases managed by combined anterior and posterior spine fusion. J Bone Jt Surg 62:705–712

    CAS  Google Scholar 

  4. Hosman AJ, Langeloo DD, de Kleuver M et al (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 27:167–175

    Article  PubMed  Google Scholar 

  5. Lowe TG (1987) Double L- rod instrumentation in the treatment of severe kyphosis secondary to Scheuermann’s disease. Spine 12:336–341

    CAS  Article  PubMed  Google Scholar 

  6. Speck GR, Chopin DC (1986) The surgical treatment of Scheuermann’s kyphosis. JBJS-Br 68:189–193

    CAS  PubMed  Google Scholar 

  7. Sturm PF, Dobson JC, Armstrong GW (1993) The surgical management of Scheuermann’s disease. Spine 18:685–691

    CAS  Article  PubMed  Google Scholar 

  8. 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 30:1528–1534

    Article  PubMed  Google Scholar 

  9. Heine J, Stauch R, Matthiass HH (1984) Results of operative treatment of Scheuermann disease. Orthop 122:743–749

    CAS  Article  Google Scholar 

  10. Herndon WA, Emans JB, Micheli LJ et al (1981) Combined anterior and posterior fusion for Scheuermann’s kyphosis. Spine 6:125–130

    CAS  Article  PubMed  Google Scholar 

  11. Otsuka NY, Hall JE, Mah JY (1990) Posteior fusion for Scheuermann’s kyphosis. Clin Orthop 251:134–139

    PubMed  Google Scholar 

  12. Ponte A, Vero B, Siccardi GL (1984) Surgical treatment of Scheuermann’s hyperkyphosin. In: Winter RB (ed) Progress in spinal pathology: kyphosis. Aulo Gaggi, Bologna, pp 75–80

    Google Scholar 

  13. Hw Scheuermann (1920) Kyphosis dorsalis juvenilis. Ugeskr Laeger 82:385

    Google Scholar 

  14. Winter RB, Hall JE (1978) Kyphosis in childhood and adolescence. Spine 3:285–308

    CAS  Article  PubMed  Google Scholar 

  15. Papagelopoulos PJ, Klassen RA, Peterson HA et al (2001) Surgical treatment of Scheuermann’s disease with segmental compression instrumentation. Clin Orthop Relate Res 386:139–149

    Article  Google Scholar 

  16. Yang C, Askin G, Yang SH (2004) Combined thoracoscopic anterior spinel release and posterior correction for Scheuermann’s kyphosis. Zhongbua Wai Ke Za Zhi 42:1293–1295 (in Chinese)

    Google Scholar 

  17. Lee SS, Lenke LG, Kuklo TR et al (2006) Comparison of Scheuermann kyphosis correction by posterior-only thoracic pedicle screw fixation versus combined anterior/posterior fusion. Spine 31:2316–2321

    Article  PubMed  Google Scholar 

  18. Geck MJ, Macagno A, Ponte A et al (2007) Posterior only treatment of Scheuermann’s kyphosis using Segmental posterior shortening and pedicle Screw Instrumentation. J Spinal Disord Tech 20:586–593

    Article  PubMed  Google Scholar 

  19. Alert V, Schlenzka D (2005) Scheuermann’s kyphosis—surgical management Euro. Spine J 14:817–827

    Article  Google Scholar 

  20. Coe JD, Smith JS, Berven S et al (2009) Complication of spinal fusion for Scheuermann kyphosis-A report of scoliosis research society morbidity and mortality committee. Spine 35:99–103

    Article  Google Scholar 

  21. Tsutsui S, Pawelek JB, Tracy P (2011) Do discs Open anteriorly with posterior—only correction of Scheuermann’s kyphosis? Spine 36:1086–1092

    Article  Google Scholar 

  22. Koller H, Juliane Z, Umstaetter M, Meier O, Schmidt R, Hitzl W (2014) Surgical treatment of Scheuermann kyphosis using a combined antero-posterior strategy and pedicle screw construct efficacy, radiographic and clinical outcomes in lll cases. Eur Spine J 23:180–191

    Article  PubMed  Google Scholar 

  23. Birnbaum K, Siebert CH, Hinkelmann J et al (2001) Correction of kyphotic deformity before and after transection of the anterior longitudinal ligament: a cadaver study. Arch Orthop Trauma Surg 121:142–147

    CAS  Article  PubMed  Google Scholar 

  24. Lowe TG, Kasten T (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 19:1680–1685

    CAS  Article  PubMed  Google Scholar 

  25. Lafage V, Bharucha NJ, Schwab F, Hart RA, Burton D, Boachie Adjei O, Smith JS, Hostin R, Shaffrey C, Gupta M, Akbarnia BA, Bess S (2012) Multicenter validation of a formula predicting postoperative spinopelvic alignment. JNS 16:15–21

    Google Scholar 

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Acknowledgments

We appreciate Dr Majid Rezvani and Dr Mohammadreza Mehrabanian for their radiographic assessment as independent reviewers.

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Affiliations

  1. Department of Orthopedic Spinal Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

    Mohammadreza Etemadifar, Alireza Ebrahimzadeh & Abdollah Hadi

  2. Department of Orthopedic, Isfahan University of Medical Sciences, Isfahan, Iran

    Mehran Feizi

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  1. Mohammadreza Etemadifar
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  2. Alireza Ebrahimzadeh
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  3. Abdollah Hadi
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  4. Mehran Feizi
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Correspondence to Abdollah Hadi.

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Etemadifar, M., Ebrahimzadeh, A., Hadi, A. et al. Comparison of Scheuermann’s kyphosis correction by combined anterior–posterior fusion versus posterior-only procedure. Eur Spine J 25, 2580–2586 (2016). https://doi.org/10.1007/s00586-015-4234-1

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  • DOI: https://doi.org/10.1007/s00586-015-4234-1

Keywords

  • Scheuermann’s disease
  • Kyphotic deformity
  • Surgical correction outcome