Prospective Comparison of Patient-selected Operative Versus Nonoperative Treatment of Scheuermann Kyphosis

Abstract

Background: Scheuermann kyphosis (SK) can be managed operatively or nonoperatively. Few studies compare the effect of operative versus nonoperative treatment on patient health-related quality of life. We compare 2-year radiographic and the Scoliosis Research Society-22 questionnaire (SRS-22) results of patients who self-selected either conservative or surgical treatment. Methods: Single institution review of prospectively collected data for patients presenting with SK from 2006 to 2014. Forty-five of 55 patients returned for 2-year follow-up. Patients were divided into operative (n=27) or nonoperative (n=18) groups based upon their self-selected method of treatment. Radiographic data and SRS-22 scores were collected at initial presentation and 2-year follow-up. Results: Operatively treated patients had larger initial sagittal Cobb angles and lower SRS-22 scores in the pain and appearance domains. Two years postoperatively, surgically treated patients had smaller Cobb angles and improved scores in these SRS-22 domains. Nonoperatively treated patients did not deteriorate over time. Conclusions: Patients who elect to receive operative treatment for SK have improved radiographic and SRS-22 parameters at 2-year follow-up compared with patients who elect nonoperative treatment. Not surprisingly, patients selecting surgical treatment had greater sagittal Cobb angles and greater levels of pain and dissatisfaction with their appearance. However, at 2-year follow-up, surgical patients experience greater (and significant) change on all parameters; exhibiting smaller Cobb angles, less pain, and greater satisfaction with their outcomes. Nonoperatively treated patients do not deteriorate over 2 years. Level of Evidence: Level II—prognostic study.

Health-related quality of life outcomes in adolescent Scheuermann’s kyphosis patients treated with posterior spinal fusion: A comparison with age- and sex-matched controls

“…Based on the previous research, surgical treatment of SK in the adolescent population results in significant improvements in HRQOL when measured using the SRS-22 outcome score. 12 , 14 , 15 …”

“…At 2 years postoperatively, the HRQOL of SK patients improved to reach equivalent values to the AIS scores. Green et al 15 compared 2-year radiographic and the SRS-22 results of 45 patients who self-selected either conservative or surgical treatment. At 2-year follow-up, surgical patients experienced a significant change on all parameters.…”

“…12 , 13 Previous studies which have assessed the HRQOL of surgically treated SK patients have compared the results with AIS patients or with non-operated SK patients. 14 , 15 To our knowledge, there are no studies which compare the effect of operative treatment to HRQOL on SK patients with age- and sex-matched healthy controls.…”

Master’s Surgical Technique: Operative Treatment of Scheuermann’s Kyphosis

“…Patients who receive operative treatment for Scheuermann's have been shown to have improvements in radiographic outcomes, less pain, and greater satisfaction compared to nonoperative patients. 15 While controversial, magnetic resonance imaging (MRI) is probably not routinely indicated on all patients as part of the preoperative assessment if pain is at the apex of the curve or in a hyper-lordotic lumbar spine below a hyper-kyphotic thoracic spine. Tight hamstrings, such as a popliteal angle of 60 degrees or less is common, especially in adolescent males and is not by itself a sign of neurologic pathology.…”

The Extension of Surgery Predicts Acute Postoperative Pain, While Persistent Postoperative Pain Is Related to the Spinal Pathology in Adolescents Undergoing Posterior Spinal Fusion

“…Spinal deformity correction requires a long posterior instrumentation, while spondylolisthesis is treated with a single or two-level lumbar fusion [ 1 ]. Previous studies have suggested that PSF reduces pain in patients with AIS and spondylolisthesis, while pain outcomes after surgery for SK remain unclear [ 3 , 4 , 5 , 6 , 7 ].…”