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Comparison of Anteroposterior to Posterior-Only Correction of Scheuermann’s Kyphosis: A Matched-Pair Radiographic Analysis of 92 Patients

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Abstract

Study Design

Retrospective radiographic benchmark study.

Objective

To evaluate the amount of instrumented correction obtained from a combined anterior/posterior (A/P) versus posterior-only (post-only) approach for Scheuermann’s kyphosis.

Summary of Background Data

An A/P approach was thought to optimize correction; however, instrumentation advances using pedicle screws allow treatment through an all-posterior approach.

Methods

A total of 166 Scheuermann’s kyphosis patients were treated between 2 centers: 90 by combined A/P approach at 1 center and 76 by post-only at the second center. From the 166 patients, a matched cohort of 92 (46 from each) was established according to preoperative sagittal (±10°) and hyperextension (HE) Cobb (±10°) measurements and matched for age and gender.

Results

In the matched-pair group, average preoperative sagittal Cobb angles were 75.9° for the A/P group versus 78.8° for the post-only group (p =.2). The HE Cobb angles were similar (52.4° vs. 51.1°; p =.6). They showed similar corrections (33.7° vs. 30.6°; p =.3) and postoperative Cobb measurements (43.4° vs. 47.1°; p =.2) as well. The number of fusion levels was 9 in the A/P group and 12 in the post-only group; the difference yielded significance (p =.02).

Conclusions

The A/P and post-only approaches averaged similar degrees of correction. The A/P patients were likely to correct more than their preoperative HE sagittal Cobb measurement, whereas the post-only group corrected close to their preoperative HE measurement. The number of fusion levels was larger with the post-only group.

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Author information

Authors and Affiliations

  1. German Scoliosis Center Bad Wildungen, Werner-Wicker Clinic, Im Kreuzfeld 4, D-34537, Bad Wildungen, Germany

    Heiko Koller MD, Oliver Meier MD, Juliane Zenner MD, Marianne Umschlaeger MD, Axel Hempfing MD & Wolfgang Hitzl PhD

  2. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, A-5020, Salzburg, Austria

    Heiko Koller MD

  3. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8233, Saint Louis, MO, 63110, USA

    Lawrence G. Lenke MD, Keith H. Bridwell MD & Linda A. Koester BS

Authors
  1. Heiko Koller MD
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  2. Lawrence G. Lenke MD
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  3. Oliver Meier MD
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  4. Juliane Zenner MD
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  5. Marianne Umschlaeger MD
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  6. Axel Hempfing MD
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  7. Wolfgang Hitzl PhD
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  8. Keith H. Bridwell MD
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  9. Linda A. Koester BS
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Corresponding author

Correspondence to Lawrence G. Lenke MD.

Additional information

The Department of Orthopaedic SurgeryeSpine Service, Washington University, received grant monies from Axial Biotech, DePuy Synthes Spine, a National Institutes of Health grant (2010e2015), and AOSpine, the Scoliosis Research Society, and Norton Healthcare, Louisville, KY (Scoli-RISK-1 study); philanthropic research funding from the Fox Family Foundation (Prospective Pediatric Spinal Deformity study); and fellowship funding from AOSpine North America (funds/fellow year).

Author disclosures: HK (none); LGL (patents with Medtronic [unpaid]; consultant for DePuy Synthes Spine, K2M, Medtronic [monies donated to a charitable foundation]; royalties from Medtronic, Quality Medical Publishing; reimbursement for meetings/courses from AOSpine, Broad-Water, DePuy Synthes Spine, K2M, Medtronic, Scoliosis Research Society, Seattle Science Foundation, Stryker Spine, The Spinal Research Foundation; OM (none); JZ (none); MU (none); AH (none); WH (none); KHB (none); LAK (none).

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Koller, H., Lenke, L.G., Meier, O. et al. Comparison of Anteroposterior to Posterior-Only Correction of Scheuermann’s Kyphosis: A Matched-Pair Radiographic Analysis of 92 Patients. Spine Deform 3, 192–198 (2015). https://doi.org/10.1016/j.jspd.2014.09.048

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  • DOI: https://doi.org/10.1016/j.jspd.2014.09.048

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