Selection of distal fusion level in posterior instrumentation and fusion of Scheuermann kyphosis: is fusion to sagittal stable vertebra necessary?

Yanık, Hakan Serhat; Ketencı, İsmail Emre; Coşkun, Tamer; Ulusoy, Ayhan; Erdem, Şevki

doi:10.1007/s00586-015-4123-7

Cited by 26 publications

(33 citation statements)

References 15 publications

(44 reference statements)

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“…6 Another criticism of the study by Cho et al 4 is that they did not include a group in which the LIV and the FLD were the same level. 8 Our article includes patients in whom the LIV and FLD correspond to the same level and confirms the findings of Cho et al 4 with current-day instrumentation techniques and a larger patient cohort.…”

Section: Discussionsupporting

confidence: 87%

“…Although only 44 patients were included, this is more than 4,7,9 or similar to 8 prior studies. Another weakness is our average follow-up of only 3.1 years.…”

Section: Discussionmentioning

confidence: 81%

“…6 Recent studies of DJK after all-pedicle screw fixation at the LIV have reported mixed results regarding the superiority of fusion to the SSV compared to above the SSV. 7,8 The aim our study is compare the incidence of DJK in SK when the distal fusion is at or below the SSV versus above the SSV in posterior-only approaches. We hypothesize that fusing at or below the SSV will result in less DJK compared to fusing above the SSV and therefore will result in lower rates of revision surgery following posterior spinal fusions (PSFs) for SK.…”

Section: Introductionmentioning

confidence: 99%

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Distal Fusion Level Selection in Scheuermann’s Kyphosis: A Comparison of Lordotic Disc Segment Versus the Sagittal Stable Vertebrae

Kim

Nemani

Boachie-Adjei

et al. 2017

Global Spine Journal

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Study Design:Retrospective study.Objective:To compare 2 methods of selecting the lowest instrumented vertebra (LIV) on the rates of revision surgery for distal junctional kyphosis (DJK) following treatment for Scheuermann’s kyphosis (SK).Methods:A retrospective review of patients who have undergone surgical treatment for SK was performed. Forty-four patients were divided into 2 groups based on intervention: Group 1 (n = 26) included patients who had an LIV distal to or at the sagittal stable vertebrae (SSV), and Group 2 (n = 18) included patients who had an LIV proximal to the SSV. For each group, demographic, radiographic, and revision surgery data was analyzed.Results:The average follow-up was 3.1 years. There were no differences among demographic variables between the groups. Preoperative and postoperative thoracic kyphosis, lumbar lordosis, and sagittal balance were not different between groups. Postoperatively, Group 1 demonstrated a significantly greater average lordotic disc angle below the LIV compared with Group 2 (Group 1, −6.2 ± 4.3° vs Group 2, −2.9 ± 5.8°; P = .02). In a subgroup analysis, extending fusions to the sagittal stable vertebra rather than the first lordotic disc resulted in fewer distal LIV complications necessitating revision surgery compared with fusing short of the SSV (5% vs 36.3%, P = .04).Conclusion:The SSV method may reduce complications secondary to distal junctional failure, but at the expense of incorporating additional motion segments in a typically young population.

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Section: Discussionsupporting

confidence: 87%

“…Although only 44 patients were included, this is more than 4,7,9 or similar to 8 prior studies. Another weakness is our average follow-up of only 3.1 years.…”

Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Distal Fusion Level Selection in Scheuermann’s Kyphosis: A Comparison of Lordotic Disc Segment Versus the Sagittal Stable Vertebrae

Kim

Nemani

Boachie-Adjei

et al. 2017

Global Spine Journal

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“…Lonner et al 16 found no significant difference for development of DJK between patients fused to SSV and those fused to the FLV. Yanik et al 25 found that extension of instrumentation and fusion into the SSV are unnecessary and fusion to the FLV was sufficient and results in comparable rates of DJK and saves more mobile levels.…”

Section: Journalmentioning

confidence: 99%

“…Others recommended fusing short of the SSV and including the first lordotic disc and fusing into the first lordotic vertebra (FLV) which is just caudal to the first lordotic disc to save at least one mobile segment. 2,4,6,16,25 Few studies used the vertebra just proximal or cephalic to the first lordotic disc. 13 In this prospective study, we used the vertebra just cephalic to the first lordotic disc (FLV-1) as the LIV to save more motion segments in the lumber spine and show the results and whether this was associated with increased incidence of DJK or revision surgery.…”

Section: Introductionmentioning

confidence: 99%

Selection of the Distal Fusion Level in Posterior-Only Surgery of Scheuermann Kyphosis: The Concept of the FLV-1

bdEllatif¹

2019

Egyptian Spine Journal

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Background Data: Lumber spine mobility is very important clinically and functionally especially in younger patients. Fusion in Scheuermann kyphosis is a long fusion surgery that usually extends into the lumber spine leaving less mobile segments. Debate has focused on the selection of the LIV. Some recommend fusing into the SSV to decrease the incidence of DJK while others use the FLV which is just caudal to the first lordotic disc as the LIV to save more motion segments. Few studies recommend fusion into the vertebra just cephalic to the first lordotic disc (FLV-1). Study Design: A prospective clinical case study. Purpose: To evaluate the outcomes of fusing into the FLV-1 in surgical treatment of SK and whether it is associated with increased incidence of distal junctional failure and DJK or not. Patients and Methods: The study included 25 patients with SK treated by posterior-only surgery using all pedicular screw instrumentation with or without posterior release/Ponte osteotomies using the FLV-1 as the LIV. The study was done in the period between February 2011 and February 2015. Patients were evaluated radiologically by full length standing biplanar X-rays and hyperextension flexibility X-ray. Parameters assessed included KA, TK, LL, and SVA for assessments of sagittal balance together with three pelvic parameters including the PI, PT, and SS angles. Clinical outcome was measured by the ODI and SRS-30 scores. Any complication encountered was documented, especially DJK, PJK, or implant failure. Results: Mean follow-up period of the patients was 40±14.88 months. The average KA improved from 82.2±9.2 • preoperatively to 38.2±5.47 • yielding 53.54% correction rate with minimal change at final follow-up of 39.9±5.47 • and 2% loss of correction. SVA improved from 6.35 mm (range, 60-40) to 12.25 mm (range, 25-10) at final follow-up. The difference between the FLV and FLV-1 was 1 segment whereas the difference between the SSV and FLV-1 was 1.7±0.47 segments (range, 1-2) and the difference between the SSV and the FLV was 0.7±0.47 segments (range, 0-1). PJK occurred in 2 patients without symptoms and another 2 patients suffered mild radiological DJK and all required no treatment. Only one patient had screw pull-out and required revision. Final SRS-30 score was 125.4±15.71 (range, 95-140) and the average ODI was 7.3±2.56 (range, 4-12) without any disability.

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Postoperative changes in sacropelvic junction in short-segment angular kyphosis versus Scheuermann kyphosis

Güler

Akgül

Korkmaz³

et al. 2016

Eur Spine J

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The results of this study suggest that a significant sacropelvic improvement can be achieved by balanced sagittal vertical axis and T1 spinopelvic leading to a good sagittal alignment of spine in patients with AK and SK. Changes seen in morphological parameters after surgery may be closely related with baseline biomechanics and structure of the spine and pelvis. Therefore, further clinical and scientific trials are necessary both to elucidate the biomechanics, their clinical implications, and to develop new techniques and models for spine and pelvis surgery.

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Selection of distal fusion level in posterior instrumentation and fusion of Scheuermann kyphosis: is fusion to sagittal stable vertebra necessary?

Abstract: Proper selection of distal fusion level is important in order to prevent DJK after SK surgery. According to this study, it is not necessary to extend the fusion down to the SSV. Fusion to FLV is sufficient and saves a level.

Cited by 26 publications

References 15 publications

Distal Fusion Level Selection in Scheuermann’s Kyphosis: A Comparison of Lordotic Disc Segment Versus the Sagittal Stable Vertebrae

Distal Fusion Level Selection in Scheuermann’s Kyphosis: A Comparison of Lordotic Disc Segment Versus the Sagittal Stable Vertebrae

Selection of the Distal Fusion Level in Posterior-Only Surgery of Scheuermann Kyphosis: The Concept of the FLV-1

Postoperative changes in sacropelvic junction in short-segment angular kyphosis versus Scheuermann kyphosis

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