Abstract
Study Design
Retrospective review of KID Inpatient Database (KID) from 2003, 2006, 2009, and 2012.
Objectives
The aim of this study was to evaluate the impact of advances in spinal surgery on patient outcomes in the treatment of Scheuermann kyphosis (SK).
Summary of Background Data
SK is one of the most common causes of back pain in adolescents. Trends in diagnoses and surgical treatment and approach to SK have not been well described.
Methods
SK patients aged 0–20 years in KID were identified by ICD-9 code 732.0. KID-supplied year- and hospital-trend weights were used to establish prevalence. Patient demographics, surgical details, and outcomes were analyzed with analysis of variance.
Results
A total of 1,070 SK patients were identified (33.2% female), with increasing incidence of SK diagnosed from 2003 to 2012 (3.6–7.5 per 100,000, p < .001). The average age of operative patients was 16.1±2.0 years and did not change (16.27–16.06 years, p = .905). The surgical rate has not changed over time (72.8%–72.8%, p = .909). Overall, 96.3% of operative patients underwent fusion, with 82.2% of cases spanning ⩾4 levels; in addition, 8.6% underwent an anterior-only surgery, 74.6% posterior-only, and 13.6% combined approach. From 2003 to 2012, rates of posterior-only surgeries increased (62.4%–84.4%, p < .001) whereas the rate of combined-approach surgeries decreased (37.6%–8.8%, p < .001). Overall complication rates for SK surgeries have decreased (2003: 20.9%; 2012: 11.9%, p = .029). Concurrently, the rate of ⩾4-level fusions has increased (43.5%–89.6%, p < .001), as well as the use of Smith-Peterson (7.8%–23.6%, p < .001) and three-column osteotomies (0.0%–2.7%, p = .011). In subanalysis comparing posterior to combined approaches, complication rates were significantly different (posterior: 9.88%, combined: 19.46%, p = .005). Patients undergoing a combined approach have a longer length of stay (LOS) than patients undergoing a posterior-only approach (7.8 vs. 5.6 days, p < .001).
Conclusions
Despite unchanged demographics and operative rates in SK, there has been a shift from combined to isolated posterior approaches, with a concurrent increase in levels treated. A combined approach was associated with increased complication rates, LOS, and total charges compared to isolated approaches. Awareness of these inherent differences is important for surgical decision making and patient education.
Levels of Evidence
Level III.
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Author disclosures: SRH (none), GWP (none), JCT (none), CAB (none), FAS (none), JYM (none), PLZ (none), MV (none), DVM (none), BMB (none), BGD (none), SV (none), MR (none), DMS (none), VL (personal fees from DePuy Synthes, NuVasive, K2M, and Medtronic; other from Nemaris, outside the submitted work), FJS (grants from DePuy Synthes and SRS; personal fees from Zimmer Biomet, NuVasive, K2M, MSD, and Medicrea; other from Nemaris INC, outside the submitted work), TJE (none), PGP (personal fees from Medicrea and SpineWave; nonfinancial support from Zimmer-Biomet and Allosource; grants from CSRS, outside the submitted work).
IRB approval: Exempt—being a study of NIS, which is publicly available and does not contain any patient-identifying information.
Funding information: No sources of funding.
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Horn, S.R., Poorman, G.W., Tishelman, J.C. et al. Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012. Spine Deform 7, 100–106 (2019). https://doi.org/10.1016/j.jspd.2018.06.004
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DOI: https://doi.org/10.1016/j.jspd.2018.06.004