A retrospective observational cohort study with a minimum follow-up of 10 years of patients who underwent surgery for Scheurmann Kyphosis (SK).
Evaluate the long-term clinical and radiological outcome of patients with SK who either underwent combined anterior–posterior surgery or posterior instrumented fusion alone.
Summary of background data
There is paucity of literature for long-term outcome studies on SK. The current trend is towards only posterior (PSF) surgical correction for SK. The combined strategy of anterior release, fusion and posterior spinal fusion (AF/PSF) for kyphosis correction has become historic relic. Long-term outcome studies comparing the two procedures are lacking in literature.
51 patients (30 M: 21F) who underwent surgery for SK at a single centre were reviewed. Nineteen had posterior instrumentation alone (PSF) (Group 1) and 32 underwent combined anterior release, fusion with posterior instrumentation (AF/PSF) (Group 2). The clinical data included age at surgery, gender, flexibility of spine, instrumented spinal levels, use of cages and morcellised rib grafts (in cases where anterior release was done), posterior osteotomies and instrumentation, complications and indications for revision surgery. Preoperative flexibility was determined by hyperextension radiographs. The radiological indices were evaluated in the pre-operative, 2-year post-operative and final follow-up [Thoracic Kyphosis (TK), Lumbar lordosis (LL), Voustinas index (VI), Sacral inclination (SI) and Sagittal vertical axis (SVA)]. The loss of correction and incidence of JK (Junctional Kyphosis) and its relation to fusion levels were assessed. Complications and difference in outcome between the two groups were analyzed.
The mean age at surgery for 51 patients was 20.6 years who were followed up for a minimum of 10 years (mean: 14 years; range 10–16 years). The mean age was 18.5 ± 2.2 years and 21.9 ± 4.8 years in groups 1 and 2, respectively. The mean pre- and 2-year post-operative ODIs were 32.6 ± 12.8 and 8.4 ± 5.4, respectively, in group 1 (p < 0.0001) and 30.7 ± 11.7 and 6.4 ± 5.7, respectively, in group 2 (p < 0.0001). The final SRS-22 scores in group 1 and 2 were 4.1 ± 0.4 and 4.0 ± 0.35, respectively (p = 0.88). The preoperative flexibility index was 49.2 ± 4.2 and 43 ± 5.6 in groups 1 and 2, respectively (p < 0.0001). The mean TKs were 81.4° ± 3.8° and 86.1° ± 6.0° for groups 1 and 2, respectively, which corrected to 45.1° ± 2.6° and 47.3° ± 4.8°, respectively, at final follow-up (p < 0.0001). The mean pre-operative LL angle was 60.0° ± 5.0° and 62.4° ± 7.6° in groups 1 and 2, respectively, which at final follow-up was 45.1° ± 4.4° and 48.1° ± 4.8°, respectively (p < 0.0001). The mean pre-operative and final follow-up Voustinas index (VI) in group 1 were 22.9 ± 2.9 and 11.2 ± 1.2, respectively, and in group 2 was 25.9 ± 3.5 and 14.0 ± 2.3, respectively. The mean pre-operative and final follow-up SI angle were 43.6° ± 3.3° and 31.2° ± 2.5° in group 1, respectively, and 44.3° ± 3.5° and 32.1° ± 3.5° in group 2, respectively (p < 0.0001). The pre-operative and final follow-up SVA in group 1 were − 3.3 ± 1.0 cms and − 1.3 ± 0.5 cms, respectively, and in group 2 was − 4.0 ± 1.3cms and − 1.9 ± 1.1cms, respectively (p < 0.0001). Though the magnitude of curve correction in the groups 1 and 2 was significant 36° vs 39° (p = 0.05), there was no significant difference in correction between the two groups. Proximal JK was seen in seven and distal JK in five patients were observed in the whole cohort.
The long-term clinical outcomes for both PSF and AF/PSF are comparable with reproducible results. No difference was noted in loss of correction and outcome scores between the two groups. The correction of thoracic kyphosis (TK) had a good correlation with ODI. AF/PSF had much higher complications than PSF group. The objective of correcting the sagittal profile and balancing the whole spinal segment on the pelvis can be achieved through single posterior approach with fewer complications.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Scheurmann HW (1977) The Classic: Kyphosis dorsalis juvenalis. Clin Orthop Relat Res 128:5–7
Sorenson K (1964) Scheurmann s juvenile kyphosis Clinical appearances radiograph etiology & prognosis. Munksgaard, Copenhagen
Murray PM, Weinstein SL, Spratt KF (1987) The natural history & long-term follow-up of Scheurmann Kyphosis. J Bone Jt Surg Am 69:50–57
Tribus CB (1998) Scheurmann Kyphosis in adolescents & adults—diagnosis and management. J Am Acad Orthop Surg 6:36–43
Speck GR, Chopin DC (1986) The surgical treatment of Scheuermann’s kyphosis. J Bone Jt Surg Br 69:189–193
Sturm PF, Dobson JC, Armstrong GW (1993) The surgical management of Scheuermann’s disease. Spine (Phila Pa) 18:685–691
Lowe TG (1990) Current concept review—Scheurmann disease. J Bone Jt Surg Am 72:940–945
Bradford DS, Moe JH, Montalvo FJ (1975) Scheurmann Kyphosis – Results of surgery treated by posterior spine athrodesis in 22 patients. J Bone Jt Surg Am 57:439–444
Taylor TC, Wenger DR, Stephen J et al (1979) Surgical management of thoracic kyphosis in adolescents. J Bone Jt Surg Am 61:496–503
Otsuka NY, Hall JE, Mah JY (1990) Posterior fusion for Scheuermann’s kyphosis. Clin Orthop Relat Res 251:134–139
Papagelopoulos PJ, Klassen RA, Peterson HA et al (2001) Surgical treatment of Scheurmann kyphosis with segmental compression instrumentation. Clin Orthop Relat Res 386:139–149
Poolman RW, Been HD, Ubags LH (2002) Clinical outcome and radiographic results after operative treatment of Scheuermann’s disease. Eur Spine J 11:561–569
Bradford DS, Ahmed KB, Moe JH et al (1980) The surgical management of patients with Scheuermann’s disease: a review of twenty-four cases managed by combined anterior and posterior spine fusion. J Bone Jt Surg Am 62:705–712
Herndon WA, Emans JB, Micheli LJ et al (1981) Combined anterior and posterior fusion for Scheuermann’s kyphosis. Spine 6:125–130
Lowe TG, Line BG (2007) Evidence based medicine: analysis of Scheurmann’s kyphosis. Spine (Phila Pa) 32:S115–S119
Lonner BS, Newton P, Betz R et al (2007) Operative management of Scheuermann’s kyphosis in 78 patients: radiographic outcomes, complications, and technique. Spine 32:2644–2652
Tsirikos AI, Jain AK (2011) Scheuermann’s kyphosis; current controversies. J Bone Jt Surg Br 93:857–864
Koller H, Juliane Z, Umstaetter M et al (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 23:180–191
Hosman AJ, Langeloo DD, deKleuver M et al (2002) Analysis of the sagittal plane after surgical management for Scheuermann disease. A view on overcorrection and the use of an anterior release. Spine 27:167–175
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
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 (Phila Pa 1976) 31:2316–2321
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 19:1680–1685
Sardar ZM, Ames RJ, Lenke L (2019) Scheuermann’s kyphosis: diagnosis, management, and selecting fusion levels. J Am Acad Orthop Surg 27(10):e462–e472
Cho K-J, Lenke L, Bridwell KH et al (2009) Selection of the optimal distal fusion level in posterior instrumentation and fusion for thoracic hyperkyphosis. Spine 34:765–770
Kim YJ, Bridwell KH, Lenke LG et al (2008) Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion. Spine 33:2179–2184
Yanik HS, Ketenci IE, Polat A et al (2015) Prevention of proximal junctional kyphosis after posterior surgery of Scheuermann kyphosis: an operative technique. J Spinal Disord Tech 28:E101–E105
Denis F, Sun E, Winter RB (2009) Incidence and risk factors for proximal and distal junctional kyphosis following treatment for Scheuermann kyphosis. Minimun five-year follow-up. Spine (Phila Pa 1976) 34:E729–E734
Yanik HS, Ketenci IE, Coskun T et al (2016) Selection of distal fusion level in posterior instrumentation and fusion of Scheuermann kyphosis: is fusion to sagittal stable vertebra necessary? Eur Spine J 25:583–589
Arun R, Mehdian SMH, Freeman BJC et al (2008) Do anterior interbody cages have a potential value in comparison to autogenous rib graft in the surgical management of Scheurmann Kyphosis? Spine J 6:413–420
Cobb JR (1948) Outline for the study of scoliosis. In: Ann Arbor JW, Edwards, (eds) Instructional Course Lectures. American Academy of Orthopaedic Surgeons. Cilt, London, pp 261–275
McAlister WH, Shackelford GD (1975) Measurement of spinal method for de fining spinal curvature in columns exhibit curvatures. Radiol Clin North Am 13:113–121
Voutsinas SA, MacEwen GD (1986) Sagittal profiles of the spine. Clin Orthop 210:235–242
Legaye J, Duval-Beaupere G, Hecquet J et al (1988) Pelvic incidence: a fundamental pelvic parameter for three dimensional regulation of spinal sagittal curves. Eur Spine J 7(2):99–103
Lehuec JC, Thomson W, Mohsinaly Y et al (2019) Sagittal balance of the spine. Eur Spine J 28(9):1889–1905
Kaiser R, Behrbalk E, Walsh M et al (2017) Can MRI predict flexibility in Scheuermann kyphosis patients? J Spinal Disord Tech 30(7):E938–E941
Ascani E, La Rosa G (1994) Scheuermann’s kyphosis. In: Weinstein SL (ed) The pediatric spine: principles and practice. Raven Press, New York, pp 557–584
Kamath S H, Sengupta D K, Mehdian S M H, et al. Sagittal balance in Scheuermann kyphosis – results of surgical treatment in 35 cases. British Scoliosis Society, Orthopaedic proceedings in The Bone & Joint J, 85B; Suppl III. March 2003
de Jonge T, Illes T, Bellyei G (2001) Surgical correction of Scheuermann’s kyphosis. Int Orthop 25:70–73
Behrbalk E, Uri O, Parks RM et al (2014) Posterior-only correction of Scheuermann kyphosis using pedicle screws: economical optimization through screw density reduction. Eur Spine J 23(10):2203–2210
Cobden A, Albayrak A, Camurcu Y et al (2017) Posterior-only approach with pedicle screws for the correction of Scheuermann’s kyphosis. Asian Spine J 11(4):513–519
Koptan WM, Elmiligui YH, Elsebaie HB (2009) All pedicle screw instrumentation for Scheuermann’s kyphosis correction: is it worth it? Spine J 9:296–330
Herrera-Soto JA, Parikh SN, Al-Sayyad MJ et al (2005) Experience with combined video-assisted thoracoscopic surgery (VATS) anterior spinal release and posterior spinal fusion in Scheuermann’s kyphosis. Spine 30:2176–2181
Deckey JE, Court C, Bradford DS (2000) Loss of sagittal plane correction after removal of spinal implants. Spine 25(19):2453–2460
Jansen RC, van Rhijn LW, van Ooij A (2006) Predictable correction of the unfused lumbar lordosis after thoracic correction and fusion in Scheuermann kyphosis. Spine (Phila Pa 1976) 31:1227–1231
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(4 Suppl):S26-33
Pelosi L, Jardine A, Webb JK (1999) Neurological complications of anterior spinal surgery for kyphosis with normal somatosensory evoked potentials (SEPs). J Neurol Neurosurg Psychiatry 66:662–664
Coe JD, Smith JS, Berven S et al (2009) Complications of spinal fusion for Scheuermann kyphosis: a report of the scoliosis research society morbidity and mortality committee. Spine 35(1):99–103
Yan C, Li Y, Yu Z (2016) Prevalence and consequence of the proximal junctional kyphosis after spinal deformity surgery. Medicine 95(20):1–6
Hart R, McCarthy I, O’brien M et al (2013) Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity. Spine (Phila Pa 1976) 38:E1223–E1227
Kim HJ, Bridwell KH, Lenke LG et al (2014) Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections. Spine (Phila Pa 1976) 39(9):E576–E580
Dikici F, Akgul T, Sariyilmaz K et al (2018) Selection of distal fusion level in terms of distal junctional kyphosis in Scheuermann kyphosis. A comparison of 3 methods. Acta Orthop Traumatol Turc 52(1):7–11
No funding was received for this work.
Conflict of interest
The authors declare that they have no conflict of interest.
Local hospital Ethical board approved.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Debnath, U.K., Quraishi, N.A., McCarthy, M.J.H. et al. Long-term outcome after surgical treatment of Scheuermann’s Kyphosis (SK). Spine Deform (2021). https://doi.org/10.1007/s43390-021-00410-7
- Scheuermann’s kyphosis
- Kyphosis correction
- Posterior spinal fusion
- Anterior release
- Combined anterior
- Posterior fusion