Mikhail V. MikhaylovskiyResearch Institute for Traumatology and Orthopaedics, Russia
Title: Long-term (over five years) results of surgical correction of Scheuermann’s kyphosis
Summary of Background Data: Despite a large number of studies on surgical correction of juvenile kyphosis, articles discussing long-term results of these interventions are very rare.
Methods: The study group included 43 patients, the mean age was 19.1 (14–32) years; the mean postoperative follow-up was 6 + 10 (5–20) years. Two-stage surgery including discectomy and interbody fusion followed by posterior correction and fusion was conducted in 35 cases (group A). Eight patients (group B) underwent only posterior correction and fusion. All basic X-ray parameters were determined for each patient immediately before surgery, one week after surgery, and at the end of the follow-up period. All patients answered the SRS-24 questionnaire.
Results: The curve decreased from 77.8° to 40.7° in group A and from 81.7° to 41.6° in group B. The loss of correction was 9.1° and 6.0° in groups A and B, respectively. The parameters of lumbar lordosis remained normal during the follow-up period. Proximal junctional kyphosis was detected in 21 out of 43 patients (48.8 %). The rate of PJK was 45.4 % in those patients whose upper end vertebra was included in the fusion and 60 % in individuals whose upper end vertebra was not included. PJK developed in eight (47.8 %) out of 17 patients who received ? 50 % kyphosis correction and in 13 (50 %) individuals who had < 50 % deformity correction. The rate of DJK development was 39.5 %. The lower instrumented vertebra (LIV) was located proximal to the sagittal stable vertebra (SSV) in 16 cases, with 12 of them being diagnosed with DJK (75 %). In 27 patients, LIV was located either at the SSV level or distal to it, the number of DJK cases was 5 (18.5 %) (P < 0.05). Only two patients with complications required unplanned interventions. The surgical outcome score (SRS-24) increases between the immediate and long-term postoperative periods for all domains and from 88.4 to 91.4 in total. The same applies to answer to the question No. 24 (“Would you have the same treatment again if you had the same condition?”): rate of positive answers ranges from 82 to 86 %.
Conclusions: Two-stage surgery has no advantages over one-stage operation. The problem of choosing the area of spinal fusion is far from being solved. Surgical treatment improves the quality of life of patients with Scheuermann’s disease.
Mikhail Mikhaylovsky has defended his doctoral thesis in 1995 in Saint Petersburg, Russia. He is the head of spine surgery department for children and adolescents of Research Institute for Traumatology and Orthopaedics in Novosibirsk city, Russia. SRS active fellow since 2014. He has over 250 publications that have been cited over 1200 times, and his publication h-index is 17. He is serving as an editorial board member of four journals in Russia, Bulgaria and Brasil.