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

Abstract

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.

The surgical management of scheurmann’s kyphosis: Efficacy and safety of a low density posterior pedicle screw construct

“…The posterior approach with osteotomies has become a popular alternative in recent years due to the link between advancements in spinal osteotomies and the development of strong fixation systems (pedicle screws that allow robust three-column fixation), resulting in shorter operation times and fewer comorbidities and problems (blood transfusion, decrease in pulmonary capacitance, hospitalisation times, and recovery times). [25][26][27][28][29] The ideal pedicle screw density (number of pedicle screws used/number of possible pedicle insertion sites) for maintaining a stable fixation following treatment of spinal abnormalities is still debated. High density screw (HDS) surgery takes longer and costs more money, and it also has a higher complication rate.…”

“…The posterior approach with osteotomies has become a popular alternative in recent years due to the link between advancements in spinal osteotomies and the development of strong fixation systems (pedicle screws that allow robust three-column fixation), resulting in shorter operation times and fewer comorbidities and problems (blood transfusion, decrease in pulmonary capacitance, hospitalisation times, and recovery times) 25–29 …”

Enfermedad de Scheuermann, abordaje con cirugía de alta tecnología

“…Se ha demostrado que el tratamiento anterior, posterior o mixto no tiene alguna diferencia en cuanto a correcciones, ya sean a corto 21,22 o largo plazo, 23 las diferencias más relevantes son el bajo riesgo de complicaciones y sangrado en el abordaje sólo posterior. 24…”

Selecting the Vertebra above Sagittal Stable Vertebra as the Distal Fusion Level in Scheuermann's Kyphosis: A Prospective Study with a Minimum of 2‐Year Follow‐Up

“…This condition is associated with radiographic features, such as vertebral wedging, irregular vertebral endplate, and Schmorl's node 3 . Posterior‐only corrective instrumentation and fusion via multi‐level Ponte osteotomy have been the principle treatment of SK patients 4–6 . However, the risk of developing distal junctional kyphosis (DJK) remains a significant concern, with a reported risk rate of around 14% 7,8 .…”

“… 3 Posterior‐only corrective instrumentation and fusion via multi‐level Ponte osteotomy have been the principle treatment of SK patients. 4 , 5 , 6 However, the risk of developing distal junctional kyphosis (DJK) remains a significant concern, with a reported risk rate of around 14%. 7 , 8 Reported risk factors related to this undesired condition included overcorrection, excessive dissection of ligamentous tissues, and improper selection of fusion levels.…”