THE OUTCOME OF ANTERIOR RELEASE, POSTERIOR INSTRUMENTATION AND CIRCUMFERENTIAL FUSION IN SCHEUERMANN’S KYPHOSIs

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THE OUTCOME OF ANTERIOR RELEASE, POSTERIOR INSTRUMENTATION AND CIRCUMFERENTIAL FUSION IN SCHEUERMANN’S KYPHOSIs

Journal Title: Journal of Turkish Spinal Surgery - Year 2006, Vol 17, Issue 1

Abstract

Scheuermann’s kyphosis is generally treated conservatively. Surgery is reserved for patients with high-degree progressive kyphotic deformiti-es and in patients with pain and neurological de-ficits. The most preferred surgical approach is posterior instrumentation and fusion. The risks associated with posterior approach include cor-rection losses and pseudoarthrosis. Therefore, recently combined anterior and anterior fusion procedures are more frequently used. Studies re-porting on the long term outcome of surgical and clinical treatments for Scheuermann’s kyphosis are not many in number. Our study population consisted of 20 young adults with a kyphotic de-formity greater than 70° who underwent anterior release, posterior correction with 3rd generation instrumentation, and anterior-posterior combined fusion and who were followed for at least 5 years. Preoperative, postoperative and final visit global thoracic and apical intersegmental kyphosis ang-les were assessed radiologically and the percent correction was determined. Clinically, patients were evaluated with SRS22 questionnaire. All patients were male with a mean age of 18.2 ± 2.1. Preoperatively, the average kyphotic angle was 89.2° ± 17.9°, and postoperatively it fell down to 40.6° ± 14.3°, with a 45.5% ±13.1% correction. The apical intersegmental angle was 24.6° ± 5.3° preoperatively, and it was reduced to 4.9° ± 2.0° postoperatively. A statistically signifi-cant correction was observed in both global tho-racal and apical intersegmental kyphosis angles (p < 0.05). No early or late infections, neurologi-cal deficits, or systemic complications occurred. In patients who received CTLSO treatment for 4 months, an average correction loss of 3.7° ± 1.4° was detected at the final visit. With regard to SRS22 scores, scores equal to or greater than 4 were obtained in all patients for all domains, and the average scores for pain, function, personal appearance, mental status, and satisfaction with treatment were 4.8 ± 0.3, 4.5 ± 0.4, 4.6 ± 0.5,4.5 ± 0.5 and 4.7 ± 0.4, respectively. The domain scores for personal appearance, mental status, and satisfaction with treatment showed a positive correlation with postoperative percent correction and a negative correlation with correction loss. Eighteen patients (90%) became completely free of pain, and the remaining 2 patients had a cor-rection loss greater than 5°. In the light of these data, we suggest that in young adults with Scheuermann’s kyphosis and a thoracal sagittal angle greater than 70°, it is possible to achieve normal sagittal contours with an intervention consis-ting of anterior release, posterior correction with 3rd generation instrumentation, and circumferen-tial fusion. Also, it seems that this surgical treat-ment method together with the use of Milwakuee brace for 4 months result in a low incidence of correction loss as well as satisfactory clinical and cosmetic results.

Authors and Affiliations

I. Teoman BENLI, Alper KAYA

Keywords

EP ID EP676486
DOI -
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