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. 2021 Jan;103-B(1):148-156.
doi: 10.1302/0301-620X.103B1.BJJ-2020-1279.R2.

The surgical treatment of severe Scheuermann's kyphosis

Athanasios I Tsirikos  1   2 , Thomas Henry Carter  1
Affiliations

The surgical treatment of severe Scheuermann's kyphosis

Athanasios I Tsirikos et al. Bone Joint J. 2021 Jan.

Erratum in

  • Corrigenda.
    Tsirikos AI, Carter TH. Tsirikos AI, et al. Bone Joint J. 2021 Apr;103-B(4):804. doi: 10.1302/0301-620X.103B4.BJJ-2021-00015. Bone Joint J. 2021. PMID: 33789490 No abstract available.

Abstract

Aims: To report the surgical outcome of patients with severe Scheuermann's kyphosis treated using a consistent technique and perioperative management.

Methods: We reviewed 88 consecutive patients with a severe Scheuermann's kyphosis who had undergone posterior spinal fusion with closing wedge osteotomies and hybrid instrumentation. There were 55 males and 33 females with a mean age of 15.9 years (12.0 to 24.7) at the time of surgery. We recorded their demographics, spinopelvic parameters, surgical correction, and perioperative data, and assessed the impact of surgical complications on outcome using the Scoliosis Research Society (SRS)-22 questionnaire.

Results: The mean follow-up was 8.4 years (2 to 14.9). There were 85 patients (96.6%) with a thoracic deformity. Posterior spinal fusion with closing-wedge osteotomies and hybrid instrumentation was used in 86 patients; two patients underwent combined anterior and posterior spinal fusion. The mean kyphosis was corrected from 94.5° to 47.5° (p < 0.001). Coronal and sagittal balance returned to normal. The rate of complications was 12.5%: there were no neurological deficits, implant failure, or revision surgery. SRS-22 scores improved from a mean 3.6 (1.3 to 4.1) to 4.6 (4.2 to 5.0) at two years (p < 0.001) with a high rate of patient satisfaction. Non-smokers and patients with lower preoperative SRS-22 scores showed greater improvement in their quality of life. Sagittal pelvic balance did not change after correction of the kyphosis and correlated with lumbar lordosis but not with thoracic or thoracolumbar kyphosis.

Conclusion: Posterior spinal fusion using hybrid instrumentation, closing-wedge osteotomies, and iliac bone grafting achieves satisfactory correction of a severe kyphosis resulting in improvements in physical and mental health and a high degree of patient-reported satisfaction. Cite this article: Bone Joint J 2021;103-B(1):148-156.

Keywords: Aetiology; Complications; Kyphosis correction; Patient-reported outcome measures; Quality of life outcomes; SRS-22 questionnaire; Scheuermann's kyphosis; Spinal fusion; Spinopelvic parameters; Treatment.

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