Surgical Treatment of Scheuermann???s Disease With Segmental Compression Instrumentation

Papagelopoulos, Panayiotis J.; Klassen, Rudolph A.; Peterson, Hamlet A.; Dekutoski, Mark B.

doi:10.1097/00003086-200105000-00018

Cited by 75 publications

(44 citation statements)

References 28 publications

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“…There is ongoing discussion regarding the appropriate end level to spare motion segments while lowering the risk of PJK and DJK [37]. Regarding UIV, there seems to be agreement concerning inclusion of at least the proximal end vertebra [24]. Hamzaoglu [38] recommended inclusion of the proximal EV and EV ?…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, overcorrection of thoracic hyperkyphosis will result in increased PJK. This in turn might cause implant loosening at the UIV and loss of correction, due to the upper noninstrumented thoracic spine and lumbar spine moving to balance the spino-pelvic parameters [3,8,14,24,30,40]. Overcorrection is more likely to occur in flexible SK, causing adjacent segment problems.…”

Section: Discussionmentioning

confidence: 99%

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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

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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.

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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

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“…O tipo de instrumentação posterior (parafusos pediculares, ganchos ou sistemas híbridos) deve também ser considerado na avaliação da perda de correção tardia. Na teoria, a realização da abordagem combinada promoveria a consolidação mais rápida no ápice da deformidade, preservando desse modo a correção obtida (14,31) . Nesse grupo de pacientes, a lordose lombar apresentou redução em relação aos valores pré-operatórios, estando de acordo com a literatura (10) , que tem correlacionado a lordose com o grau de correção da cifose (10,19,32) , apresentando aumento do seu valor no seguimento tardio (10,32) .…”

Section: Discussionunclassified

Osteotomias segmentares múltiplas para a correção da cifose

Herrero¹,

Porto²,

Nogueira-Barbosa³

et al. 2009

Rev. bras. ortop.

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rESUMOObjetivo: Avaliar o resultado do tratamento cirúrgico da hipercifose dorsal da coluna vertebral por meio da técnica de Ponte (osteotomias múltiplas posteriores). Métodos: Estudo retrospectivo de 10 pacientes (oito com sequela de doença de Scheuermann e dois com sequela de laminectomia) submetidos a cirurgia para correção de hipercifose acima de 70°. A idade variou de 12 anos a 20 anos (média de 16,8 anos ± 2,89). Os parâmetros radiográficos estudados foram a mensuração da cifose, lordose e, quando presente, da escoliose. Também foram avaliadas a presença de cifose juncional proximal e distal, a perda da correção e complicações como soltura e quebra dos implantes. Os parâmetros radiográficos foram avaliados no período pré-operatório, pós-operatório imediato e avaliação tardia. Resultados: Os pacientes foram seguidos por um período que variou de 24 a 144 meses (média de 65,8 meses ± 39,92). O valor médio da hipercifose pré-operatória foi de 78,8º ± 7,59º (Cobb) e de 47,5º ± 12,54º no seguimento, com a média de correção de 33,9º ± 9,53º e perda média de correção de 2,2º. Conclusão: O tratamento cirúrgico da hipercifose torácica por meio de osteotomias múltiplas posteriores apresentou boa correção da deformidade e perda mínima de correção ao longo do seguimento. descritores -

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“…Although a combined approach increases operative time and thoracotomy-related morbidity, it does decrease failure and pseudarthrosis rates associated with the hardware. 4,25 Of note, staged surgery with interval traction has not been shown to improve the overall deformity correction. 16 Neuromonitoring should be performed throughout spinal deformity correction surgery to provide timely warning of spinal cord compromise that may occur during necessary corrective maneuvers.…”

Section: Operative Managementmentioning

confidence: 99%

Combined anterior–posterior fusion with laterally placed threaded interbody cages and pedicle screws for Scheuermann kyphosis

Moquin¹,

Rosner²,

Cooper³

2003

FOC

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The authors report their preferred method for correcting Scheuermann disease via a combined anterior–posterior approach; their procedure is associated with a lower morbidity rate than the standard approach. Twenty-month follow-up examination demonstrated excellent maintenance of correction. The results satisfied the requirements to function without restriction in a vigorous military environment.

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Surgical Treatment of Scheuermann???s Disease With Segmental Compression Instrumentation

Cited by 75 publications

References 28 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

Osteotomias segmentares múltiplas para a correção da cifose

Combined anterior–posterior fusion with laterally placed threaded interbody cages and pedicle screws for Scheuermann kyphosis

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