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European Spine Journal

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01-08-2016 | Original Article

Comparison of Scheuermann’s kyphosis correction by combined anterior–posterior fusion versus posterior-only procedure

Authors: Mohammadreza Etemadifar, Alireza Ebrahimzadeh, Abdollah Hadi, Mehran Feizi

Published in: European Spine Journal | Issue 8/2016

Abstract

Introduction

Conventional treatment of rigid deformity in Scheuermann’s kyphosis (SK) in young patients includes a preliminary anterior spinal release and fusion (ASF) followed by posterior spinal fusion and instrumentation (PSF). However, recently there are more trends to do posterior-only surgery for correction of this deformity. The aim of our study was to compare clinical and radiological outcomes of ASF/PSF and PSF-only procedures in treatment of SK.

Materials and methods

In a prospective clinical and radiological review, thirty operated SK patients in two groups were evaluated. Group A: ASF/PSF technique (n: 16) and group B: PSF-only procedure (n: 14) were followed for at least 2 years (average 57.6 months). Two groups were well matched for the following four criteria: average age, flexibility status, posterior fusion levels, and preoperative Cobb’s kyphosis angle. Oswestry disability index (ODI) and scoliosis research society questionnaire-30 (SRS-30) and radiological (kyphosis correction, correction loss, sagittal balance) parameters were evaluated before and after surgery and at the final follow-up.

Results

In group A, primary thoracic Cobb’s kyphosis, immediate post-operative kyphosis, and final follow-up kyphosis angle were 83.6°, 41.4° and 43°, respectively (P < 0.05). Correction rate and correction loss were 50.5 % and 1.6° ± 2.4, respectively. In group B, the corresponding values were 81.9°, 40.1° and 43.2°, respectively (P < 0.05). Correction rate and correction loss were 51 % and 3.1° ± 2.5, respectively. SRS-30 and ODI scores in group A were averaged 68.5 and 21.3 preoperatively and 128.7 and 6.25 at the final follow-up, respectively. In group B, the corresponding values were 64 and 23.2 preoperatively and 133.5 and 5.8 at the final follow-up, respectively.

Conclusions

Clinical and radiological parameters were similar in both groups after surgical correction while, complication rates, operation time and blood loss were significantly higher in ASF/PSF procedure.

Scheuermann’s Sorensen KH (1964) Juvenile Kyphosis. Enjar Munkesgaard Forlag, Copenhagen, pp 214–222

Bradford DS, Moe JH, Montalvo FJ et al (1975) Scheuermann’s Khphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients. J Bone Jt Surg 57:439–448

Bradford DS, Ahmad KB, Moe JH et al (1980) The surgical management of scheuermann’s disease : a review of twenty-four cases managed by combined anterior and posterior spine fusion. J Bone Jt Surg 62:705–712

Hosman AJ, Langeloo DD, de Kleuver M et al (2002) Analysis of the sagittal plane after surgical management for Scheuermann’s disease: a view on overcorrection and the use of an anterior release. Spine 27:167–175CrossRefPubMed

Lowe TG (1987) Double L- rod instrumentation in the treatment of severe kyphosis secondary to Scheuermann’s disease. Spine 12:336–341CrossRefPubMed

Speck GR, Chopin DC (1986) The surgical treatment of Scheuermann’s kyphosis. JBJS-Br 68:189–193PubMed

Sturm PF, Dobson JC, Armstrong GW (1993) The surgical management of Scheuermann’s disease. Spine 18:685–691CrossRefPubMed

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 30:1528–1534CrossRefPubMed

Heine J, Stauch R, Matthiass HH (1984) Results of operative treatment of Scheuermann disease. Orthop 122:743–749CrossRef

10.

Herndon WA, Emans JB, Micheli LJ et al (1981) Combined anterior and posterior fusion for Scheuermann’s kyphosis. Spine 6:125–130CrossRefPubMed

11.

Otsuka NY, Hall JE, Mah JY (1990) Posteior fusion for Scheuermann’s kyphosis. Clin Orthop 251:134–139PubMed

12.

Ponte A, Vero B, Siccardi GL (1984) Surgical treatment of Scheuermann’s hyperkyphosin. In: Winter RB (ed) Progress in spinal pathology: kyphosis. Aulo Gaggi, Bologna, pp 75–80

13.

Hw Scheuermann (1920) Kyphosis dorsalis juvenilis. Ugeskr Laeger 82:385

14.

Winter RB, Hall JE (1978) Kyphosis in childhood and adolescence. Spine 3:285–308CrossRefPubMed

15.

Papagelopoulos PJ, Klassen RA, Peterson HA et al (2001) Surgical treatment of Scheuermann’s disease with segmental compression instrumentation. Clin Orthop Relate Res 386:139–149CrossRef

16.

Yang C, Askin G, Yang SH (2004) Combined thoracoscopic anterior spinel release and posterior correction for Scheuermann’s kyphosis. Zhongbua Wai Ke Za Zhi 42:1293–1295 (in Chinese)

17.

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 31:2316–2321CrossRefPubMed

18.

Geck MJ, Macagno A, Ponte A et al (2007) Posterior only treatment of Scheuermann’s kyphosis using Segmental posterior shortening and pedicle Screw Instrumentation. J Spinal Disord Tech 20:586–593CrossRefPubMed

19.

Alert V, Schlenzka D (2005) Scheuermann’s kyphosis—surgical management Euro. Spine J 14:817–827CrossRef

20.

Coe JD, Smith JS, Berven S et al (2009) Complication of spinal fusion for Scheuermann kyphosis-A report of scoliosis research society morbidity and mortality committee. Spine 35:99–103CrossRef

21.

Tsutsui S, Pawelek JB, Tracy P (2011) Do discs Open anteriorly with posterior—only correction of Scheuermann’s kyphosis? Spine 36:1086–1092CrossRef

22.

Koller H, Juliane Z, Umstaetter M, Meier O, Schmidt R, Hitzl W (2014) Surgical treatment of Scheuermann kyphosis using a combined antero-posterior strategy and pedicle screw construct efficacy, radiographic and clinical outcomes in lll cases. Eur Spine J 23:180–191CrossRefPubMed

23.

Birnbaum K, Siebert CH, Hinkelmann J et al (2001) Correction of kyphotic deformity before and after transection of the anterior longitudinal ligament: a cadaver study. Arch Orthop Trauma Surg 121:142–147CrossRefPubMed

24.

Lowe TG, Kasten T (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 19:1680–1685CrossRefPubMed

25.

Lafage V, Bharucha NJ, Schwab F, Hart RA, Burton D, Boachie Adjei O, Smith JS, Hostin R, Shaffrey C, Gupta M, Akbarnia BA, Bess S (2012) Multicenter validation of a formula predicting postoperative spinopelvic alignment. JNS 16:15–21

Title: Comparison of Scheuermann’s kyphosis correction by combined anterior–posterior fusion versus posterior-only procedure
Authors: Mohammadreza Etemadifar
Alireza Ebrahimzadeh
Abdollah Hadi
Mehran Feizi
Publication date: 01-08-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 8/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-4234-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparison of Scheuermann’s kyphosis correction by combined anterior–posterior fusion versus posterior-only procedure

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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