Abstract
Purpose
Anterior release for Scheuermann’s disease was considered an important technique for decades. However, posterior-only surgery for Scheuermann’s disease has shown a promising potential to manage this deformity, as well. Correction loss could happen post-operatively, especially when posterior-only surgery is performed in the early days. Therefore, a dispute regarding anterior release for Scheuermann’s disease exists.
Methods
We performed a systematic review of studies, reporting the outcomes of anterior release and posterior fusion surgery (AP group) or posterior-only surgery (PO group) for Scheuermann’s disease. Data pooling and a meta-analysis with a random-effects model were performed to evaluate the results.
Results
Twenty-three studies met the inclusion criteria. The pooled correction loss of Cobb angle for the AP group was 4.1(3.4, 4.8), and for the PO group, it was 3.8(3.3, 4.4). The overall effects of blood loss, surgery time, proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), self-image improvement, pain relief, and return-to-surgery were compared between the two groups.
Conclusions
A systematic review of the outcomes of Scheuermann’s disease demonstrated a very similar correction loss for the AP group and the PO group. A meta-regression supported that correction loss did decrease as time moved on for the PO procedure, which could be explained by the improvements to instrumentation and techniques. For other outcomes, the PO group showed advantages in blood loss, surgery time, and junctional kyphosis. Similar outcomes were observed in relation to aspects of cosmetic improvement and pain relief for the AP and PO groups. The revision rate was mildly lower in the PO group than in the AP group.
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References
An HS (1999) Juvenile kyphosis. In: Herkowitz HN et al (eds) Rothman-Simeone: the spine, 4th edn. Saunders, Philadelphia
Lowe TG (1999) Scheuermann’s disease. Orthop Clin North Am 30:475–487
Bradford DS, Moe JH, Montalvo FJ et al (1974) Scheuermann’s kyphosis and roundback deformity: results of Milwaukee brace treatment. J Bone Joint Surg Am 56:740–758
Murray PM, Weinstein SL, Spratt KF (1993) The natural history and longterm follow-up of Scheuermann kyphosis. J Bone Joint Surg Am 75:236–248
Sachs B, Bradford DS, Winter R et al (1987) Scheuermann kyphosis: follow-up of Milwaukee brace treatment. J Bone Joint Surg Am 69:50–57
Tribus CB (1998) Scheuermann Kyphosis in adolescents and adults: diagnosis and management. J Am Acad Orthop Surg 6:36–43
Ferguson AB (1950) Roentgen interpretations and decisions in scoliosis. In: Edwards JW (ed) Instructional course lectures, 7th edn. American Academy of Orthopaedic Surgeons, Ann Arbor
Morrissy RT, Goldsmith GS, Hall EC et al (1990) Measurement of the Cobb angle on radiographs of patients who have scoliosis: evaluation of intrinsic error. J Bone Joint Surg Am 72:320–327
Gennari JM, Aswad R, Ripoll B, Bergoin M (1997) Indications for surgery in so-called ‘‘regular’’ thoracic and thoracolumbar kyphosis. Eur Spine J 6:25–32
Kostuik JP (1988) Anterior Kostuik–Harrington distraction systems. Orthopedics 11:1379–1391
Ali RM, Green DW, Patel TC (1999) Scheuermann’s kyphosis. Curr Opin Pediatr 11:70–75
Speck GR, Chopin DC (1986) The surgical treatment of Scheuermann’s kyphosis. J Bone Joint Surg Am 68:189–193
Arun R, Mehdian SM, Freeman BJ, Sithole J, Divjina SC (2006) Do anterior interbody cages have a potential value in comparison to autogenous rib graft in the surgical management of Scheuermann’s kyphosis? Spine J 6(4):413–420. doi:10.1016/j.spinee.2005.10.016
Geck MJ, Macagno A, Ponte A, Shufflebarger HL (2007) The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech 20(8):586–593. doi:10.1097/BSD.0b013e31803d3b16
Herrera-Soto JA, Parikh SN, Al-Sayyad MJ, Crawford AH (2005) Experience with combined video-assisted thoracoscopic surgery (VATS) anterior spinal release and posterior spinal fusion in Scheuermann’s kyphosis. Spine (Phila Pa 1976) 30(19):2176–2181
Lamartina C (2010) Posterior surgery in Scheuermann’s kyphosis. Eur Spine J 19(3):515–516. doi:10.1007/s00586-010-1351-8
Taylor TC, Wenger DR, Stephen J, Gillespie R, Bobechko WP (1979) Surgical management of thoracic kyphosis in adolescents. J Bone Joint Surg Am 61(4):496–503
Etemadifar M, Ebrahimzadeh A, Hadi A, Feizi M (2015) Comparison of Scheuermann’s kyphosis correction by combined anterior-posterior fusion versus posterior-only procedure. Eur Spine J. doi:10.1007/s00586-015-4234-1
Koller H, Juliane Z, Umstaetter M, Meier O, Schmidt R, Hitzl W (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(1):180–191. doi:10.1007/s00586-013-2894-2
Bradford DS, Ahmed KB, Moe JH, Winter RB, Lonstein JE (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 Joint Surg Am 62(5):705–712
Cho KJ, Lenke LG, Bridwell KH, Kamiya M, Sides B (2009) Selection of the optimal distal fusion level in posterior instrumentation and fusion for thoracic hyperkyphosis: the sagittal stable vertebra concept. Spine (Phila Pa 1976) 34(8):765–770. doi:10.1097/BRS.0b013e31819e28ed
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(11):1227–1231. doi:10.1097/01.brs.0000217682.53629.ad
Lim M, Green DW, Billinghurst JE, Huang RC, Rawlins BA, Widmann RF, Boachie-Adjei O (2004) Scheuermann kyphosis: safe and effective surgical treatment using multisegmental instrumentation. Spine (Phila Pa 1976) 29(16):1789–1794
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 (Phila Pa 1976) 19(15):1680–1685
Omidi-Kashani F, Ebrahimzadeh MH, Birjandinejad A (2013) Radiographic outcome of surgical treatment of scheuermann’s kyphosis: a comparative study between old and new spinal instruments. Iran Red Crescent Med J 15(4):377–378. doi:10.5812/ircmj.2621
Poolman RW, Been HD, Ubags LH (2002) Clinical outcome and radiographic results after operative treatment of Scheuermann’s disease. Eur Spine J 11(6):561–569. doi:10.1007/s00586-002-0418-6
Atici T, Aydinli U, Akesen B, Serifoglu R (2004) Results of surgical treatment for kyphotic deformity of the spine secondary to trauma or Scheuermann’s disease. Acta Orthop Belg 70(4):344–348
de Jonge T, Illés T, Bellyei Á (2001) Surgical correction of Scheuermann’s kyphosis. Int Orthop 25(2):70–73. doi:10.1007/s002640100232
Johnston CE 2nd, Elerson E, Dagher G (2005) Correction of adolescent hyperkyphosis with posterior-only threaded rod compression instrumentation: is anterior spinal fusion still necessary? Spine (Phila Pa 1976) 30(13):1528–1534
Koptan WM, Elmiligui YH, Elsebaie HB (2009) All pedicle screw instrumentation for Scheuermann’s kyphosis correction: is it worth it? Spine J 9(4):296–302. doi:10.1016/j.spinee.2008.05.011
Lee SS, Lenke LG, Kuklo TR, Valente L, Bridwell KH, Sides B, Blanke KM (2006) Comparison of Scheuermann kyphosis correction by posterior-only thoracic pedicle screw fixation versus combined anterior/posterior fusion. Spine (Phila Pa 1976) 31(20):2316–2321. doi:10.1097/01.brs.0000238977.36165.b8
Lonner BS, Newton P, Betz R, Scharf C, O’Brien M, Sponseller P, Shufflebarger H (2007) Operative management of Scheuermann’s kyphosis in 78 patients: radiographic outcomes, complications, and technique. Spine (Phila Pa 1976) 32(24):2644–2652. doi:10.1097/BRS.0b013e31815a5238
Bradford DS, Moe JH, Montalvo FJ, Winter RB (1975) Scheuermann’s kyphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients. J Bone Joint Surg Am 57(4):439–448
Papagelopoulos PJ, Klassen RA, Peterson HA, Dekutoski MB (2001) Surgical treatment of Scheuermann’s disease with segmental compression instrumentation. Clin Orthop Relat Res 386:139–149
Reinhardt P, Bassett GS (1990) Short segmental kyphosis following fusion for Scheuermann’s disease. J Spinal Disord 3(2):162–168
Ferreira-Alves A, Resina J, Palma-Rodrigues R (1995) Scheuermann’s kyphosis. The Portuguese technique of surgical treatment. J Bone Joint Surg Br 77(6):943–950
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Yun, C., Shen, C.L. Anterior release for Scheuermann’s disease: a systematic literature review and meta-analysis. Eur Spine J 26, 921–927 (2017). https://doi.org/10.1007/s00586-016-4632-z
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DOI: https://doi.org/10.1007/s00586-016-4632-z