Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases

Abstract

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.

Scheuermann’s Disease: New Impressions of Clinical and Radiological Evaluation and Treatment Approaches; A Narrative Review

“…In patients, who experienced operating correction of SK, 45% stated enhanced self-image, 41% described no change, and 14% described deteriorated self-image (42,54). However, patients, who experienced surgery showed high general satisfaction rates, up to 96% (Figures 3, 4) (52,58,59). …”

“…However, videoassisted thoracoscopic surgery for anterior spinal release decreased the overall thoracoscopic complications (50)(51)(52). The most communal peri-operative operating hitches related to the surgical procedure include neurological discrepancies like paraplegia, wound infections, and respiratory problems, particularly in cases with thoracotomy process (28,54,55), in longstanding complications, pseud arthrosis by recurring deformity, hardware failure, and proximal and distal junctional kyphosis are the most common (42,53,57,58). Surgical reconsideration is obligatory in about 17% of patients (28,59).…”

Surgical treatment of kyphosis in children with scheuermann’s diseaseusing 3D-CT navigation

“…[6], в кото-рой проводится анализ хирургического лечения 68 пациентов. Имеются также мультицентровые исследования, выполненные зарубежными авто-рами [13,15] и посвященные ретроспективному анализу хирургической коррекции деформации позвоночника у пациентов с болезнью Шейермана из комбинированного и дорсального доступов. В этих исследованиях группы наблюдения соста-вили 78 и 111 пациентов соответственно.…”

“…Одни исследователи используют лами-нарные и гибридные спинальные системы [5,7], другие авторы подчеркивают важность и значи-мость использования в качестве опорных элемен-тов транспедикулярных винтов [11,14], позво-ляющих избежать или снизить количество таких осложнений, как несостоятельность каудального или краниального захвата металлоконструкции, развитие контактного кифоза, нарушение балан-са туловища [10][11][12][13]. Необходимо отметить, что использование в качестве опорных элементов транспедикулярных винтов, особенно в верхне-грудном и среднегрудном отделе деформирован-ного позвоночника, сопряжено с риском развития различных осложнений, таких как перфорация стенок основания дуги позвонка, пролабиро-вание винта в позвоночный канал со стенозом последнего, развитие неврологических нарушений и возможное повреждение магистральных сосу-дов.…”

“…[6], в кото-рой проводится анализ хирургического лечения 68 пациентов. Имеются также мультицентровые исследования, выполненные зарубежными авто-рами [13,15] и посвященные ретроспективному анализу хирургической коррекции деформации …”