Scheuermann Kyphosis. Single Posterior Approach Or Anterior Release And Posterior Instrumentation?

Introduction: There is still debate regarding the optimal operative technique for the Scheurmann-kyphosis. A retrospective review of patients with a postoperative follow-up of at least 3 years was performed. The two study groups were: 1. Posterior instrumentation, 2. Anterior release and posterior instrumentation.

Material/Methods: 55 patients (11 females, 44 males; mean age 27 y). 14 had single posterior approach, 41 had preceding anterior release and posterior instrumentation.

Results:
Group 1: Mean follow-up 6.3 years (5 - 9). Mean preop kyphosis was 73 (62 -110 ), postop corrected to a mean of 37 (30 -65 ).

Group 2: Mean follow-up 5.2 years (3 - 7) The mean preopetrative kyphosis was of 78 (72 - 110 ) and was corrected to a mean of 32 (20 - 50 ). The patients belonging to group 1 had a loss of correction of mean 4 after one year follow-up and fo 6 after the third year while in the second group there was a loss of correction of 2 after one year and no further loss of correction was seen in the three years follow-up.

Complications:
Group 1: 1 temporary neurologic deficit, 2 implant failures and 2 proximal junctional kyphosis.

Group2: 1 proximal juinctional kyphosis. Three patients of the first group underwent revision surgery. The stationary treatment required in the second group 5 days longer, including one day in intensive care unit.

Conclusion: The combined approach showed an accurate segmental correction through restoration of the anterior vertebral height and a better correction of the kyphosis. In this group there were no neurologic complications and no pseudoarthrosis. The patients who were treated using a single posterior approach showed also a good correction of the kyphosis but a poor segmental correction in the apex. The stationary treatment was shorter but the loss of correction and the complication rate was higher when compared to the other group.