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Reciprocal Changes in Sagittal Alignment With Operative Treatment of Adolescent Scheuermann Kyphosis—Prospective Evaluation of 96 Patients

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Abstract

Introduction

Sagittal alignment abnormalities in Scheuermann kyphosis (SK) strongly correlate with quality of life measures. The changes in spinopelvic parameters after posterior spinal fusion have not been adequately studied. This study is to evaluate the reciprocal changes in spinopelvic parameters following surgical correction for SK.

Methods

Ninety-six operative SK patients (65% male; age 16 years) with minimum 2-year follow-up were identified in the prospective multicenter study. Changes in spinopelvic parameters and the incidence of proximal (PJK) and distal (DJK) junctional kyphosis were assessed as were changes in Scoliosis Research Society–22 (SRS-22) questionnaire scores.

Results

Maximum kyphosis improved from 74.4° to 46.1° (p < .0001), and lumbar lordosis was reduced by 10° (−63.3° to −53.3°; p < .0001) at 2-year postoperation. Pelvic tilt, sacral slope, and sagittal vertical axis remained unchanged. PJK and DJK incidence were 24.2% and 0%, respectively. In patients with PI <45°, patients who developed PJK had greater postoperative T2–T12 (54.8° vs. 44.2°, p = .0019), and postoperative maximum kyphosis (56.4° vs. 44.6°, p = .0005) than those without PJK. In patients with PI ≥45°, patients with PJK had less postoperative T5–T12 than those without (23.6° vs. 32.9°, p = .019). Thoracic and lumbar apices migrated closer to the gravity line after surgery (−10.06 to −4.87 mm, p < .0001, and 2.28 to 2.10 mm, p = .001, respectively). Apex location was normalized to between T5–T8 in 68.5% of patients with a preoperative apex caudal to T8, whereas 90% of patients with a preoperative apex between T5 and T8 remained unchanged. Changes in thoracic apex location and lumbar apex translation were associated with improvements in the SRS function domain.

Conclusion

PJK occurred in 1 in 4 patients, a lower incidence than previously reported perhaps because of improved techniques and planning. Both thoracic and lumbar apices migrated closer to the gravity line, and preoperative apices caudal to T8 normalized in more than two-thirds of patients, resulting in improved postoperative function. Individualizing kyphosis correction to prevent kyphosis and PI mismatch may be protective against PJK.

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Authors and Affiliations

  1. Mount Sinai Hospital, E 101st St, New York, NY, 100029, USA

    Baron S. Lonner MD & Yuan Ren PhD

  2. CHU Sainte-Justine Hospital Montreal, 3175 Ch de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada

    Stefan Parent MD

  3. Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA

    Suken A. Shah MD

  4. Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA

    Paul Sponseller MD

  5. Rady Children’s Hospital San Diego, 3020 Children’s Way, San Diego, CA, 92123, USA

    Burt Yaszay MD & Peter O. Newton MD

  6. Shriners Hospital for Children, 3551 N Broad St, Philadelphia, PA, 19140, USA

    Amer F. Samdani MD & Joshua M. Pahys MD

  7. The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Patrick J. Cahill MD

  8. Institute for Spine & Scoliosis, 3100 Princeton Pike, Lawrenceville, NJ, 08648, USA

    Randal Betz MD

  9. Miami Children’s Hospital, 3100 SW 62nd Ave, Miami, FL, 33155, USA

    Harry L. Shufflebarger MD

Authors
  1. Baron S. Lonner MD
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  2. Stefan Parent MD
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  3. Suken A. Shah MD
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  4. Paul Sponseller MD
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  5. Burt Yaszay MD
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  6. Amer F. Samdani MD
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  7. Patrick J. Cahill MD
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  8. Joshua M. Pahys MD
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  9. Randal Betz MD
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  10. Yuan Ren PhD
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  11. Harry L. Shufflebarger MD
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  12. Peter O. Newton MD
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Corresponding author

Correspondence to Baron S. Lonner MD.

Additional information

BSL (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation; personal fees from DePuy Synthes Spine, K2M, Paradigm Spine, Spine Search, and Ethicon; nonfinancial support from Spine Deformity journal; grants from AO Spine, John and Marcella Fox Fund Grant, and OREF, outside the submitted work); SP (other from Scoliosis Research Society, Canadian Spine Society, DePuy Synthes Spine, Medtronic, EOS Imaging, and K2M; grants from DePuy Synthes Spine, Setting Scoliosis Straight Foundation, Medtronic, EOS Imaging, Spinologics, Canadian Institutes of Health Research, Canadian Foundation for Innovation, Natural Sciences and Engineering Council of Canada, Fonds de Recherche Québec—Santé, Orthopaedic Research and Education Foundation, and the Academic Chair in Pediatric Spinal Deformities of CHU Ste-Justine, outside the submitted work; in addition, SP has a patent Spinologics issued); SAS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine and K2M, outside the submitted work); PS (grants and personal fees from DePuy Synthes Spine; personal fees from JBJS, EBIX / Oakstone Medical Publishers, and Globus, outside the submitted work); BY (grants from DePuy Synthes through Setting Scoliosis Straight, during the conduct of the study; grants and personal fees from DePuy Synthes and K2M; personal fees from NuVasive, Globus, Medtronic, and Stryker, outside the submitted work; in addition, BY has a patent K2M with royalties paid); AFS (grants from DePuy Synthes Spine, during the conduct of the study; personal fees from DePuy Synthes Spine, Ethicon, Globus Medical, Msonix, Stryker, and Zimmer Biomet; other from Setting Scoliosis Straight Foundation, Scoliosis Research Society, and Children’s Spine Study Group, outside the submitted work); PJC (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; other from DePuy Synthes Spine; personal fees from DePuy, Ellipse Technologies, and Globus Medical; personal fees and other from Medtronic, outside the submitted work; and the study was conducted using the Harms Study Group CP Database [The Harms Study Group receives funding from the Setting Scoliosis Straight Foundation]; is a board or committee member of the American Academy of Orthopaedic Surgeons, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society; and is in the editorial or governing board of the Journal of Bone and Joint Surgery—American and Spine Deformity); JMP (other from DePuy Synthes, outside the submitted work); RB (grants from DePuy Synthes Spine, during the conduct of the study; personal fees and other from Abyrx and Apifix; other from Advanced Vertebral Solutions; personal fees from DePuy Synthes Spine, Globus Medical, and Medtronic; other from MiMedx, Orthobond, and Medovex; personal fees and other from SpineGuard; personal fees from Zimmer Biomet, outside the submitted work; and Son Randal Jr. works for DePuy Synthes Spine); YR (grants from Setting Scoliosis Straight Foundation, during the conduct of the study); HLS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation, outside the submitted work); PON (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation; other from Rady Children’s Specialists; grants and personal fees from DePuy Synthes Spine; personal fees from the law firm of Carroll, Kelly, Trotter, Franzen & McKenna and from the law firm of Smith, Haughey, Rice & Roegge; grants from NIH and OREF; grants and other from SRS; grants from EOS imaging; personal fees from Thieme Publishing; other from NuVasive; personal fees from Ethicon Endosurgery; other from Electrocore; personal fees from Cubist; other from International Orthopedic Think Tank and Orthopediatrics Institutional Support; personal fees from K2M, outside the submitted work; in addition, PON has a patent “Anchoring Systems and Methods for Correcting Spinal Deformities” [8540754] with royalties paid to DePuy Synthes Spine; a patent “Low Profile Spinal Tethering Systems” [8123749] issued to DePuy Spine; a patent “Screw Placement Guide” [7981117] issued to DePuy Spine; and a patent “Compressor for Use in Mnimally Invasive Surgery” [7189244] issued to DePuy Spine).

IRB approval: This study was reviewed and approved by Mount Sinai Hospital Institutional Review Board.

This study was supported by a grant from DePuy Synthes to Setting Scoliosis Straight Foundation in support of the Harms Study Group’s research.

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Lonner, B.S., Parent, S., Shah, S.A. et al. Reciprocal Changes in Sagittal Alignment With Operative Treatment of Adolescent Scheuermann Kyphosis—Prospective Evaluation of 96 Patients. Spine Deform 6, 177–184 (2018). https://doi.org/10.1016/j.jspd.2017.07.001

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  • DOI: https://doi.org/10.1016/j.jspd.2017.07.001

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