Sagittal Plane Alignment and Functional Outcomes Following Surgery for Scheuermann Kyphosis^[*]

Abstract

Objective To evaluate and correlate the pelvic parameters, the sagittal balance (SB), and the functional outcome of the patients submitted to surgical treatment for Scheuermann hyperkyphosis (SK).

Methods Patients submitted to surgery between January 2005 and December 2016 were included. The following radiographic measurements were obtained: thoracic kyphosis (TK); lumbar lordosis (LL); SB; pelvic incidence (PI); pelvic tilt (PT); and sacral slope (SS). Complications during the follow-up period were recorded.

Results A total of 19 patients were included (16 males): the mean preoperative kyphosis was of 83°, and the postoperative kyphosis was of 57°. The mean preoperative lumbar lordosis was of 66°, with a postoperative spontaneous correction of 47°. Regarding the preoperative pelvic parameters, the average PI, PT and SS were of 48°,10° and 39° respectively. In the postoperative period, these values were of 50°, 16° and 35° respectively. The preoperative SB was neutral, and it was maintained after the surgical correction. Concerning complications during the follow-up period, three junctional kyphosis were observed–two requiring revision surgery, one nonunion, and one dehiscence of the surgical wound. Regarding the functional results, the average score on the Scoliosis Research Society-22 (SRS-22) patient questionnaire was of 4.04, and we verified that the SB obtained in the postoperative period had no influence on the functional outcome (p = 0.125) nor on the postoperative LL (p = 0.851).

Conclusion We verified a spontaneous improvement in the lumbar hyperlordosis at levels not included in the fusion after correction of the TK. Although the postoperative functional results were globally high, we did not find any statistically significant relationship with TK nor LLs. high PI is associated with a greater rate of complications regarding the proximal junctional kyphosis (PJK), and these pelvic parameters should be considered at the time of the SK surgical treatment.

Keywords

Scheuermann disease - spine - thoracic vertebrae - spinal fusion - kyphosis

• Referências

• 1 Wood KB, Melikian R, Villamil F. Adult Scheuermann kyphosis: evaluation, management, and new developments. J Am Acad Orthop Surg 2012; 20 (02) 113-121
• 2 Damborg F, Engell V, Andersen M, Kyvik KO, Thomsen K. Prevalence, concordance, and heritability of Scheuermann kyphosis based on a study of twins. J Bone Joint Surg Am 2006; 88 (10) 2133-2136
• 3 Sorensen K. Scheuermann's Juvenile Kyphosis: Clinical Practice, Appearances, Radiography, Aetiology and Prognosis. Philadelphia: Lippincott Williams & Wilkins; 2001
• 4 Le Huec J, Aunoble S, Philippe L, Nicolas P. Pelvic parameters: origin and significance. Eur Spine J 2011; 20 (Suppl. 05) 564-571
• 5 Lonner BS, Newton P, Betz R. et al. Operative management of Scheuermann's kyphosis in 78 patients: radiographic outcomes, complications, and technique. Spine (Phila Pa 1976) 2007; 32 (24) 2644-2652
• 6 Tyrakowski M, Mardjetko S, Siemionow K. Radiographic spinopelvic parameters in skeletally mature patients with Scheuermann disease. Spine (Phila Pa 1976) 2014; 39 (18) E1080-E1085
• 7 Kim YJ, Bridwell KH, Lenke LG, Glattes CR, Rhim S, Cheh G. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up. Spine (Phila Pa 1976) 2008; 33 (20) 2179-2184
• 8 El-Hawary R, Sturm PF, Cahill PJ. et al. Sagittal spinopelvic parameters of young children with scoliosis. Spine Deform 2013; 1 (05) 343-347
• 9 Roussouly P, Gollogly S, Berthonnaud E, Labelle H, Weidenbaum M. Sagittal alignment of the spine and pelvis in the presence of L5-s1 isthmic lysis and low-grade spondylolisthesis. Spine (Phila Pa 1976) 2006; 31 (21) 2484-2490
• 10 Tanguay F, Mac-Thiong JM, de Guise JA, Labelle H. Relation between the sagittal pelvic and lumbar spine geometries following surgical correction of adolescent idiopathic scoliosis. Eur Spine J 2007; 16 (04) 531-536
• 11 Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 2009; 34 (17) E599-E606
• 12 Schwab F, Lafage V, Patel A, Farcy J-P. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976) 2009; 34 (17) 1828-1833
• 13 Hosman AJ, Langeloo DD, de Kleuver M, Anderson PG, Veth RP, Slot GH. Analysis of the sagittal plane after surgical management for Scheuermann's disease: a view on overcorrection and the use of an anterior release. Spine (Phila Pa 1976) 2002; 27 (02) 167-175
• 14 Poolman RW, Been HD, Ubags LH. Clinical outcome and radiographic results after operative treatment of Scheuermann's disease. Eur Spine J 2002; 11 (06) 561-569
• 15 de Jonge T, Illés T, Bellyei A. Surgical correction of Scheuermann's kyphosis. Int Orthop 2001; 25 (02) 70-73
• 16 Ashraf A, Noelle Larson A, Polly DW, Ferski G, Guidera KJ, Mielke CH. Change in Sagittal Plane Alignment Following Surgery for Scheuermann's Kyphosis. Spine Deform 2014; 2 (05) 404-409
• 17 Lonner BS, Parent S, Shah SA. et al. Reciprocal Changes in Sagittal Alignment With Operative Treatment of Adolescent Scheuermann Kyphosis-Prospective Evaluation of 96 Patients. Spine Deform 2018; 6 (02) 177-184
• 18 Mac-Thiong JM, Labelle H, Berthonnaud E, Betz RR, Roussouly P. Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J 2007; 16 (02) 227-234
• 19 Cahill PJ, Steiner CD, Dakwar E. et al; Harms Study Group. Sagittal spinopelvic parameters in Scheuermann's kyphosis: a preliminary study. Spine Deform 2015; 3 (03) 267-271
• 20 Lamartina C, Berjano P. Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J 2014; 23 (06) 1177-1189
• 21 Guler O, Akgul T, Korkmaz M. et al. Postoperative changes in sacropelvic junction in short-segment angular kyphosis versus Scheuermann kyphosis. Eur Spine J 2017; 26 (03) 928-936
• 22 Bederman SS, Farhan S, Hu X. et al. Sagittal Spinal and Pelvic Parameters in Patients With Scheuermann's Disease: A Preliminary Study. Int J Spine Surg 2019; 13 (06) 536-543
• 23 Yanik HS, Ketenci IE, Coskun T, Ulusoy A, Erdem S. Selection of distal fusion level in posterior instrumentation and fusion of Scheuermann kyphosis: is fusion to sagittal stable vertebra necessary?. Eur Spine J 2016; 25 (02) 583-589
• 24 Zhu W, Sun X, Pan W. et al. Curve patterns deserve attention when determining the optimal distal fusion level in correction surgery for Scheuermann kyphosis. Spine J 2019; 19 (09) 1529-1539
• 25 Coe JD, Smith JS, Berven S. et al. Complications of spinal fusion for scheuermann kyphosis: a report of the scoliosis research society morbidity and mortality committee. Spine (Phila Pa 1976) 2010; 35 (01) 99-103
• 26 Denis F, Sun EC, Winter RB. Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spine (Phila Pa 1976) 2009; 34 (20) E729-E734
• 27 Ghasemi A, Stubig T, , A Nasto L, Ahmed M, Mehdian H. Distal junctional kyphosis in patients with Scheuermann's disease: a retrospective radiographic analysis. Eur Spine J 2017; 26 (03) 913-920
• 28 Sardar ZM, Ames RJ, Lenke L. Scheuermann's Kyphosis: Diagnosis, Management, and Selecting Fusion Levels. J Am Acad Orthop Surg 2019; 27 (10) e462-e472
• 29 Lonner B, Yoo A, Terran JS. et al. Effect of spinal deformity on adolescent quality of life: comparison of operative scheuermann kyphosis, adolescent idiopathic scoliosis, and normal controls. Spine (Phila Pa 1976) 2013; 38 (12) 1049-1055
• 30 Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005; 30 (18) 2024-2029