Comparison of Scheuermann Kyphosis Correction by Posterior-Only Thoracic Pedicle Screw Fixation Versus Combined Anterior/Posterior Fusion

Lee, Stanley S.; Lenke, Lawrence G.; Kuklo, Timothy R.; Valente, T. Luis; Bridwell, Keith H.; Sides, Brenda; Blanke, Kathy

doi:10.1097/01.brs.0000238977.36165.b8

Cited by 130 publications

(90 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With most patients having LIV at the first-lordotic disc in our study, the number of levels fused could be limited to eight on average, indicating a mobile lumbar spine in most patients. In other studies, fusion length averaged 11 [36], 12 [29] and 13 levels [28] or was not reported [3,8]. There is ongoing discussion regarding the appropriate end level to spare motion segments while lowering the risk of PJK and DJK [37].…”

Section: Discussionmentioning

confidence: 99%

“…In our review of literature (Table 2) which included a total of 727 patients, with an average sample size of 29 and mean age of 20 years, three studies reported on clinical outcomes using validated measures. Flexibility data were reported only by Koptan (in %) [23], Lee (in %) [29], Johnston (in %) [36], Herera-soto (in°) [28] and Hosman (in°) [8]. There has been no study yet comparing both strategies based on comparable preoperative kyphosis and flexibility in a sufficiently large sample.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases

et al. 2013

View full text Add to dashboard Cite

Introduction There is sparse literature on how best to correct Scheuermann's kyphosis (SK). The efficacy of a combined strategy with anterior release and posterior fusion (AR/PSF) with regard to correction rate and outcome is yet to be determined. Materials and methods A review of a consecutive series of SK patients treated with AR/PSF using pedicle screwrod systems was performed. Assessment of demographics, complications, surgical parameters and radiographs including flexibility and correction measures, proximal junctional kyphosis angle (JKA ? 1) and spino-pelvic parameters was performed, focusing on the impact of curve flexibility on correction and clinical outcomes. Results 111 patients were eligible with a mean age of 23 years, follow-up of 24 months and an average of eight levels fused. Cobb angle at fusion level was 68°preoper-atively and 37°postoperatively. Flexibility on traction films was 34 % and correction rate 47 %. Postoperative and follow-up Cobb angles were highly correlated with preoperative bending films (r = 0.7, p \ 0.05). Screw density rate was 87 %, with increased correction with higher screw density (p \ 0.001, r = 0.4). Patients with an increased junctional kyphosis angle (JKA ? 1) were at higher risk of revision surgery (p = 0.049). 22 patients sustained complication, and 21 patients had revision surgery. 42 patients with C24 months follow-up were assessed for clinical outcomes (follow-up rate for clinical measures was 38 %). This subgroup showed no significant differences regarding baseline parameters as compared to the whole group. Median approach-related morbidity (ArM) was 8.0 %, SRS-sum score was 4.0, and ODI was 4 %. There was a significant negative correlation between the SRS-24 self-image scores and the number of segments fused (r = -0.5, p \ 0.05). Patients with additional surgery had decreased clinical outcomes (SRS-24 scores, p = 0.004, ArM, p = 0.0008, and ODI, p = 0.0004). Conclusion The study highlighted that AR/PSF is an efficient strategy providing reliable results in a large singlecenter series. Results confirmed that flexibility was the decisive measure when comparing surgical outcomes with different treatment strategies. Findings indicated that changes at the proximal junctional level were impacted by individual spino-pelvic morphology and determined by the individually predetermined thoracolumbar curvature and sagittal balance. Results stressed that in SK correction, reconstruction of a physiologic alignment is decisive to achieving good clinical outcomes and avoiding complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases

et al. 2013

View full text Add to dashboard Cite

show abstract

“…No primeiro grupo, o grau médio de correção foi de 52%, após seguimento médio de 31,7 meses, enquanto no segundo grupo de pacientes a média foi de 54,6%, após seguimento médio de 67,5 meses. Dos 18 pacientes do primeiro grupo, nove tiveram complicações, enquanto oito dos 21 pacientes do segundo grupo apresentaram complicações como cifose funcional proximal e distal, paraplegia imediatamente após o procedimento posterior, tendo-se procedido à retirada emergencial do material (18) .…”

Section: Discussionunclassified

Parafusos pediculares no tratamento da cifose de Scheuermann: resultados e complicações

Macedo¹,

Fim²,

Fontes³

2008

Rev. bras. ortop.

View full text Add to dashboard Cite

toracotomia aberta, seguida por instrumentação posterior com sistema de parafuso pedicular vertebral posicionados pela técnica de mão livre. Pré-operatoriamente, os pacientes foram analisados pela escala analógica visual (EVA) de dor e radiografias. No pós-operatório, foi analisado o grau de correção da curva, complicações, EVA para dor e nível de satisfação com a cirurgia. A média de seguimento foi de 37,5 meses (12,6-61,7 meses). Resultados: Cifose pré-operatória variou de 66° a 94°, com mé-dia de 77,6°, e média da EVA de 6,6 pontos. No pós-operatório a cifose média foi de 35,8° (variação de 23° a 50°), sendo obtida média de correção de 53,8%. A EVA foi de 0,6 ponto, com todos os pacientes, exceto um, satisfeitos com o resultado da cirurgia. Dentre as complicações: soltura de dois parafusos em um paciente, com necessidade de reintrodução e extensão da instrumentação, um paciente com infecção superficial resolvida clinicamente, uma quebra assintomática de parafuso e um paciente com infecção tardia resolvida com a retirada do implante. Conclusão: O tratamento cirúrgi-co da cifose de Scheuermann, usando liberação e fusão anterior por toracotomia aberta seguida por instrumentação posterior com sistema de parafuso pedicular vertebral por meio da técnica de mão livre, mostrou-se, nessa série de pacientes, segura e eficiente. Descritores

show abstract

“…Therefore, we opted to use a sample projected to a work of greater international importance, involving 39 patients, which was conducted partly retrospectively and partly prospectively, and published in 2006 by Lee et al (20) . Our sample consisted of 28 patients, divided into two groups, and operated at different times.…”

Section: Methodsmentioning

confidence: 99%

Cifose de Scheuermann: comparação entre a abordagem por via posterior associada à osteotomia de Smith-Petersen e a fusão combinada anterior e posterior

Temponi¹,

Macedo²,

Pedrosa³

et al. 2011

Rev. bras. ortop.

View full text Add to dashboard Cite

This article is available online in Portuguese and ABSTRACTObjective: Surgical treatment of Scheuermann's kyphosis (SK) remains a subject under discussion. In view of the controversy over the best form of surgical tr otomy. Methods: This was a descriptive case-control study with cross-sectional analysis. Twenty-eight patients, split into two groups conducted at different times, were evaluated. Results: The first group comprised patients treated using the double approach, with an average age of 19 years, preoperative kyphosis of 77.6°, postoperative kyphosis of 35.8° and average correction of 53.2%. The second group comprised patients treated using the posterior route associated with Smith-Petersen osteotomy, with a mean age of 27.3 years, preoperative kyphosis of 72.9°, postoperative kyphosis of 44.3° and average correction of 39.3%. Analysis between the two groups showed statistically significant differences in the following variables: age (p = 0.02), postoperative kyphosis (p = 0.04) and degree and percentage of kyphosis correction (p = 0.001). There was no difference concerning preoperative kyphosis (p = 0.33). In the assessment of postoperative pain (VAS), the first group presented an average of 0.6, versus 0.5 in the second group. There were only minor complications: seven in the first group and two in the second. Conclusion: The two surgical techniques studied proved to be adequate for treating SK. In the present study, the deformity correction was greater in the first group, while the pain VAS results were better in the second group, with lower incidence of complications.

show abstract

Comparison of Scheuermann Kyphosis Correction by Posterior-Only Thoracic Pedicle Screw Fixation Versus Combined Anterior/Posterior Fusion

Abstract: With less operating time and intraoperative blood loss, posterior-only Scheuermann kyphosis treatment with thoracic pedicle screws achieved and maintained better correction, and had significantly less complications than with circumferential fusion.

Cited by 130 publications

References 17 publications

Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases

Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases

Parafusos pediculares no tratamento da cifose de Scheuermann: resultados e complicações

Cifose de Scheuermann: comparação entre a abordagem por via posterior associada à osteotomia de Smith-Petersen e a fusão combinada anterior e posterior

Contact Info

Product

Resources

About