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Selection of the optimal distal fusion level for Scheuermann kyphosis with different curve patterns: when can we stop above the sagittal stable vertebra?

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Abstract

Purpose

To investigate the optimal lowest instrumented vertebra (LIV) in the treatment of Scheuermann kyphosis (SK) with different curve patterns.

Methods

Fifty-two SK patients who underwent posterior surgery between January 2010 and December 2017 with a minimum follow-up of 2 years were retrospectively reviewed. Patients were divided into two groups based on the curve pattern: the Scheuermann thoracic kyphosis (STK group) or Scheuermann thoracolumbar kyphosis (STLK group). Based on the relationship between the sagittal stable vertebra (SSV) and LIV, both groups were further divided into the SSV group and SSV-1 group. Radiographic parameters, distal junctional kyphosis (DJK) incidence and SRS-22 questionnaire scores were evaluated.

Results

In STK and STLK groups, there were no significant differences in most pre- and postoperative radiographic assessments between SSV and SSV-1 subgroups. DJK incidence showed no significant differences between groups during follow-up (P > 0.05). LIV-PSVL was significantly more negative in the SSV-1 group than that in the SSV group (P < 0.001). Within the SSV-1 group, patients with DJK showed a more negative LIV-PSVL (P = 0.039). Moderate correlation was observed between preoperative LIV-PSVL and DJK with a Spearman coefficient of − 0.474 (P = 0.035). Receiver operative characteristic curve analysis showed that the threshold value of preoperative LIV-PSVL to predict DJK was − 37.35 mm (area under the curve 0.882).

Conclusion

Shorter fusion stopping at SSV-1 achieved comparable clinical outcomes and did not increase the risk of DJK for both STK and STLK patients. For patients whose preoperative LIV-PSVL <  − 37.35 mm, extending fusion to SSV is an acceptable solution to prevent DJK.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (NSFC) (No. 82072518), the Nanjing Medical Science and Technique Development Foundation (No. QRX17126) funds and Jiangsu Provincial Key Medical Center.

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Authors and Affiliations

  1. Division of Spine Surgery, Department of Orthopedic Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China

    Yanjie Xu, Zongshan Hu, Linlin Zhang, Abdukahar Kiram, Chen Ling, Zezhang Zhu, Yong Qiu & Zhen Liu

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  1. Yanjie Xu
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Xu, Y., Hu, Z., Zhang, L. et al. Selection of the optimal distal fusion level for Scheuermann kyphosis with different curve patterns: when can we stop above the sagittal stable vertebra?. Eur Spine J 31, 1710–1718 (2022). https://doi.org/10.1007/s00586-021-07039-0

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