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Analysis of cervical sagittal alignment change following correction of thoracic and thoracolumbar Scheuermann’s kyphosis



To analyse pre-operative and post-operative changes of cervical sagittal alignment (CSA) in Scheuermann’s kyphosis (SK) patients.


64 SK and 33 control patients were retrospectively reviewed. Whole spine X-rays obtained at pre-op, 3 months post-op and at latest follow-up were reviewed and ten separate CSA radiological parameters were measured. Patients were divided in three groups: thoracic SK (TK group, apex T6–T9, n = 40), thoracolumbar SK (TLK group, apex T10–T12, n = 24), and controls.


Pre-operative C2–C7 lordosis was 21.1° ± 8.1°(TK), 6.1° ± 5.0°(TLK), and 11.4° ± 8.3° in control group and correlated significantly with T1 slope in both SK groups (r = 0.640, r = 0.772). Pre-operative T1 slope was dependent on deformity type, thoracic kyphosis (TK, β = 0.445), and lumbar lordosis (LL, β = −0.354). At final follow-up C2–C7 lordosis decreased to 15.7° ± 5.5° in TK, and increased to 12.1° ± 4.1° in TLK group. C2–C7 lordosis changes linearly correlated with T1 slope changes post-operatively (r = 0.721). Post-operative T1 slope showed linear correlation with post-operative changes in TK (β = 0.728) and pelvic tilt (PT, β = 0.539) in TK, and LL (β = −0.669), thoracolumbar kyphosis (TLK, β = −0.434), and PT (β = 0.760) in TLK group.


Our study suggests that SK is not a homogenous group of patients. Two patterns of pre- and post-operative CSA are demonstrated in TK and TLK groups. T1 slope is the most important parameter in determining pre-operative CSA and correlates with other regional anatomical parameters (TK and LL). Post-operative CSA adaptations also correlate with T1 slope post-operative changes. However, post-surgical T1 slope correlates with different parameters in the two SK groups (TK and PT in TK group; TLK, LL, and PT in TLK group).

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  1. Damborg F, Engell V, Andersen M et al (2006) Prevalence, concordance, and heritability of Scheuermann kyphosis based on a study of twins. J Bone Jt Surg Am 88:2133–2136. doi:10.2106/JBJS.E.01302

    Google Scholar 

  2. Lowe TG (1990) Scheuermann disease. J Bone Jt Surg Am 72:940–945

    Article  CAS  Google Scholar 

  3. Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ames CP, Smith JS, Scheer JK et al (2012) Impact of spinopelvic alignment on decision making in deformity surgery in adults: a review. J Neurosurg Spine 16:547–564. doi:10.3171/2012.2.SPINE11320

    Article  PubMed  Google Scholar 

  5. Loder RT (2001) The sagittal profile of the cervical and lumbosacral spine in Scheuermann Thoracic Kyphosis. J Spinal Disord 14:226–231. doi:10.1097/00002517-200106000-00007

    Article  CAS  PubMed  Google Scholar 

  6. Jiang L, Qiu Y, Xu L et al (2014) Sagittal spinopelvic alignment in adolescents associated with Scheuermann’s kyphosis: a comparison with normal population. Eur Spine J 23:1420–1426. doi:10.1007/s00586-014-3266-2

    Article  PubMed  Google Scholar 

  7. Janusz P, Tyrakowski M, Kotwicki T, Siemionow K (2015) Cervical Sagittal Alignment in Scheuermann Disease. Spine (Phila Pa 1976) 40:E1226–E1232. doi:10.1097/BRS.0000000000001129

    Article  Google Scholar 

  8. Sørensen KH, Cour AI (1964) Scheuermann’s Juvenile Kyphosis. Copenhagen

  9. Bradford DS (1977) Juvenile kyphosis. Clin Orthop Relat Res 128:45–55

    Google Scholar 

  10. Lonner BS, Newton P, Betz R et al (2007) Operative management of Scheuermann’s kyphosis in 78 patients: radiographic outcomes, complications, and technique. Spine (Phila Pa 1976) 32:2644–2652. doi:10.1097/BRS.0b013e31815a5238

    Article  Google Scholar 

  11. Cho K-J, Lenke LG, Bridwell KH et al (2009) Selection of the optimal distal fusion level in posterior instrumentation and fusion for thoracic hyperkyphosis. Spine (Phila Pa 1976) 34:765–770. doi:10.1097/BRS.0b013e31819e28ed

    Article  Google Scholar 

  12. Janusz P, Tyrakowski M, Yu H, Siemionow K (2016) Reliability of cervical lordosis measurement techniques on long-cassette radiographs. Eur Spine J 25:3596–3601. doi:10.1007/s00586-015-4345-8

    Article  PubMed  Google Scholar 

  13. Cecchinato R, Langella F, Bassani R et al (2014) Variations of cervical lordosis and head alignment after pedicle subtraction osteotomy surgery for sagittal imbalance. Eur Spine J 23(Suppl 6):644–649. doi:10.1007/s00586-014-3546-x

    Article  PubMed  Google Scholar 

  14. Ha Y, Schwab F, Lafage V et al (2014) Reciprocal changes in cervical spine alignment after corrective thoracolumbar deformity surgery. Eur Spine J 23:552–559. doi:10.1007/s00586-013-2953-8

    Article  PubMed  Google Scholar 

  15. Nasto LA, Perez-Romera AB, Shalabi ST et al (2016) Correlation between preoperative spinopelvic alignment and risk of proximal junctional kyphosis after posterior-only surgical correction of Scheuermann kyphosis. Spine J 16:S26–S33. doi:10.1016/j.spinee.2015.12.100

    Article  PubMed  Google Scholar 

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Correspondence to Luigi Aurelio Nasto.

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Nasto, L.A., Shalabi, S.T., Perez-Romera, A.B. et al. Analysis of cervical sagittal alignment change following correction of thoracic and thoracolumbar Scheuermann’s kyphosis. Eur Spine J 26, 2187–2197 (2017).

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