Selection of distal fusion level in terms of distal junctional kyphosis in Scheuermann kyphosis. A comparison of 3 methods

Dikici, Fatih; Akgül, Turgut; Sariyilmaz, Kerim; Korkmaz, Murat; Özkunt, Okan; Şar, Cüneyt; Domaniç, Ünsal

doi:10.1016/j.aott.2017.11.012

Cited by 16 publications

(9 citation statements)

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“…As shown in Figure 3 , nine studies [ 5 , 6 , 10 , 14 , 17 , 21 , 22 ] reported the correction effect by PO, and one [ 14 ] of the included studies reported two PO cohorts. Thus, totally ten PO cohorts were pooled into the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Likewise, only two studies [ 16 , 18 ] compared postoperative PJK incidence between AP and PO cohorts, and pooled analysis of PJK incidence showed no difference, as shown in Figure 5 . Four studies [ 4 , 5 , 15 , 18 ] have reported incidence of distal junctional kyphosis (DJK), but no studies compared the incidence of postoperative DJK between AP and PO cohorts. The PJK incidence was reported to range from 0% to 31%.…”

Section: Resultsmentioning

confidence: 99%

“…Scheuermann's kyphosis (SK) is a rigid developmental thoracic kyphosis, which can cause severe back pain and cosmetic disorders to patients [ 1 , 2 ]. Although conservative treatment measures are initially applied, surgical treatment is indicated for kyphosis that is over 70–75 degrees, with significant pain that has not responded to conservative management, and/or respiratory problems due to severe kyphosis, and neurological issues [ 3 – 5 ]. The surgical treatment consists of two different ways; one is the combined anterior-posterior approach (AP) and the other is a posterior-only way (PO), with various types of anchors [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Surgical Procedures Used for Correction of Scheuermann’s Kyphosis: A Meta-Analysis

Liu

2021

Pain Research and Management

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Objectives. Scheuermann’s kyphosis can cause severe back pain and cosmetic disorders to patients. Previous studies on surgical procedure selection for correction of Scheuermann’s kyphosis have drawn controversial conclusions. Here, a meta-analysis was performed to figure out a better way between anterior-posterior (AP) combined procedures and posterior-only (PO) procedures. Methods. We searched PubMed database and Ovid database, as well as Cochrane Library (between January 2009 and December 2020, around recent ten years), for studies reporting Scheuermann’s kyphosis correction in an anterior way or a posterior way. Random effects meta-analysis regarding correction degrees and incidence of proximal junctional kyphosis (PJK) was performed. Results. Finally, 13 unique studies including 586 patients (AP: 300; PO: 286) were identified and included for this meta-analysis. Overall, 6 AP cohorts and 10 PO cohorts were pooled regarding the correction degrees of kyphosis in the analysis, respectively. Pooled correction degrees in AP cohorts were 33.31 (95% CI: 27.48–39.15; I2 = 86%, P < 0.001 ) and in PO cohorts were 31.16 (95% CI: 26.97–35.35; I2 = 81.1%, P < 0.001 ). Comparison of correction between AP and PO cohorts did not indicate any significant difference. Likewise, postoperative PJK incidence showed no difference. Back pain can be caused by both AP and PO procedures, but which causes less pain remains to be conclusive. The PO approach showed less blood loss and shorter surgical duration as compared to the AP approach. Conclusions. In summary, this meta-analysis shows similar treatment effects between AP and PO procedures in correcting Scheuermann’s kyphosis, suggesting the advantage of PO procedures due to less blood loss and surgical duration. However, the postoperative complications PJK and distal junctional kyphosis (DJK) cannot be well concluded due to the limitation of existing data.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Procedures Used for Correction of Scheuermann’s Kyphosis: A Meta-Analysis

Liu

2021

Pain Research and Management

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“…They thought that it might be the reason behind iliopsoas hematoma. 24 , 25 In general, the rate of iliopsoas hematoma post minimally invasive spine surgery is low. 26 , 27 In a review article discussing the complications associated with minimally invasive lateral interbody fusion, comparing prepsoas with transpsoas approaches, the authors found that the incidence rate of hematoma to be 1.5% (in 1,398 patients) and 1.7% (in 1,198 patients) respectively, without statistical significance.…”

Section: Discussionmentioning

confidence: 99%

<p>Psoas Hematoma and Late Femoral Nerve Palsy After Extreme Lateral Interbody Fusion and Posterior Spinal Fusion with Instrumentation: A Case Report</p>

Almazrua

Almarshad

Binzuman

et al. 2020

ORR

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Introduction: Psoas hematoma is an uncommon complication following spinal surgeries. It has been reported in both extreme lateral interbody fusion (XLIF) and posterior spinal fusion with instrumentation. Minimally invasive techniques are gaining popularity in recent years due to the appealing advantages of reduced operative time, blood loss, hospital stay, and faster recovery. Case Presentation: We are presenting a case of a 77-year-old male with chronic low back pain, diagnosed to have multilevel degenerative disc disease with central and foraminal disc protrusion at L2-L3, L3-L4, L4-L5 with secondary spinal stenosis, underwent XLIF at L3-L4, L4-L5 and then 2nd stage with posterior L3-L5 fusion with pedicle screws. On the fourth day post-operatively, the patient had flank pain and dropping hemoglobin with femoral nerve palsy symptoms, a CT scan revealed a large psoas hematoma. Conservative management was decided on; a follow-up CT scan and examination showed complete resolution of the hematoma and femoral nerve recovery. Discussion: The approach to iliopsoas hematoma post spinal surgeries remains controversial. Iliopsoas hematoma should be suspected in any patients post spinal surgeries even with delayed presentations. The decision to proceed with either surgical intervention or conservative management depends on multiple factors, including patient hemodynamic status, progression of collection and femoral nerve palsy. Conclusion: The exact cause of iliopsoas hematoma post different spinal surgery approaches remains vague. In our opinion, other causes including pre-and post-operative anticoagulants should be investigated. Rushing to drain iliopsoas hematomas in case of femoral nerve palsy might not be the ideal option. Instead, monitoring patient responses to resuscitation and taking a watch and wait approach for femoral nerve palsy might be the proper approach.

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“…Another issue is development of proximal and distal junctional deformities, a certain percentage of which require unplanned reoperations. The collective experience of many surgeons has made it possible to determine a number of risk factors for the development of these deformities; however, even these recommendations are not always applicable [13][14][15][16][17][18]. The data of assessing the quality of life of patients after surgery using various questionnaires provides an ambiguous picture [19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Long-Term (Over Five Years) Results of Surgical Correction of Scheuermann’s Kyphosis

Mikhaylovskiy

Gubina

Alshevskaya³

et al. 2021

Preprint

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Study design. Retrospective cohort study.Objective. The study objective is to assess long-term results of surgical correction of kyphosis due to Scheuermann’s disease.Summary of Background Data. Despite a large number of studies on surgical correction of juvenile kyphosis, articles discussing long-term (over five years) results of these interventions are very rare.Methods. The study group included 43 patients (m/f ratio, 34/9). The mean age was 19.1 (14–32) years; the mean postoperative follow-up was 6 + 10 (5–20) years. Two-stage surgery including discectomy and interbody fusion followed by posterior correction and fusion was conducted in 35 cases (group A). Eight patients (group B) underwent only posterior correction and spinal fusion. The following parameters were determined for each patient: Thoracic Kyphosis (TK); Lumbar Lordosis (LL), Sagittal Vertical Axis (SVA); Sagittal Stable Vertebra (SSV); First Lordotic Vertebra (FLV); Proximal Junctional Angle (PJA); and Distal Junctional Angle (DJA). All measurements were performed immediately before surgery, one week after surgery, and at the end of the follow-up period. All patients answered the SRS-24 questionnaire after surgery and at end of the follow-up.Results. Groups A and B were comparable in age and sex, BMI and initial Cobb angle (P < 0.05). The curve decreased from 77.8° to 40.7° in group A and from 81.7° to 41.6° in group B. The loss of correction was 9.1° and 6.0° in groups A and B, respectively. At ID < 1.2, deformity correction and correction loss were 35° (44.0 %) and 7.1°, respectively; at ID ˃ 1.2, deformity correction and correction loss were 44.5° (54.7 %) and 3.9°, respectively (P < 0.05).Proximal junctional kyphosis was detected in 21 out of 43 patients (48.8 %). The rate of PJK was 45.4 % in those patients whose upper end vertebra was included in the fusion and 60 % in individuals whose upper end vertebra was not included. PJK developed in eight (47.8 %) out of 17 patients who received ≥ 50 % kyphosis correction and in 13 (50 %) individuals who had < 50 % deformity correction. The rate of DJK development was 39.5 %. The lower instrumented vertebra (LIV) was located proximal to the sagittal stable vertebra in 16 cases, with 12 of them being diagnosed with DJK (75 %). In 27 patients, LIV was located either at the SSV level or distal to it, the number of DJK cases was 5 (18.5 %) (P < 0.05). Only two patients with complications required unplanned interventions. According to the patient questionnaires, the surgical outcome score increases between the immediate and long-term postoperative periods for all domains and from 88.4 to 91.4 in total. The same applies to answer to the question No. 24 (“Would you have the same treatment again if you had the same condition?”): rate of positive answers ranges from 82 to 86 %.Conclusions. Two-stage surgery, as a more difficult and prolonged one, has no advantages over one-stage operation in terms of magnitude and stability of the achieved effect. The problem of choosing the area of spinal fusion is far from being solved. Surgical treatment improves the quality of life of patients with Scheuermann’s disease; the improvement is also observed in the long-term postoperative period.

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Selection of distal fusion level in terms of distal junctional kyphosis in Scheuermann kyphosis. A comparison of 3 methods

Cited by 16 publications

References 23 publications

Surgical Procedures Used for Correction of Scheuermann’s Kyphosis: A Meta-Analysis

Surgical Procedures Used for Correction of Scheuermann’s Kyphosis: A Meta-Analysis

<p>Psoas Hematoma and Late Femoral Nerve Palsy After Extreme Lateral Interbody Fusion and Posterior Spinal Fusion with Instrumentation: A Case Report</p>

Long-Term (Over Five Years) Results of Surgical Correction of Scheuermann’s Kyphosis

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