Posterior-only versus combined anterior-posterior fusion in Scheuermann disease: a systematic review and meta-analysis

OBJECTIVECombined anterior-posterior (AP) surgery is considered the gold standard for surgical treatment of Scheuermann kyphosis. There are trends toward posterior-only (PO) surgery for correcting this deformity because of the availability of multisegmental compression instruments and posterior shortening osteotomy. To date, surgical strategies for Scheuermann kyphosis remain controversial. The purpose of this study was to compare various surgical approaches for the treatment of Scheuermann kyphosis, including radiological correction and intraoperative outcomes, using a systematic review and meta-analysis.METHODSA comprehensive database search of PubMed, EMBASE, Web of Science, and Cochrane Library was performed to identify studies concerning Scheuermann kyphosis. The inclusion criteria were direct comparisons between AP and PO surgeries for Scheuermann kyphosis and assessment of the angle of thoracic kyphosis preoperatively and postoperatively. The authors used the principles of a cumulative meta-analysis by updating the pooled estimate of the treatment effect.RESULTSData from 13 studies involving 1147 participants (542 patients in the AP group and 605 patients in the PO group) were included. The average age was 18.2 years for the AP and 17.9 years for the PO group. The overall mean difference of changes in thoracic kyphosis angles between the AP and PO surgeries was 0.23° (95% CI −2.24° to 2.71°). In studies in which posterior shortening osteotomies were not performed, PO surgery resulted in a significantly low degree of correction of thoracic kyphosis, with a mean difference of 5.59° (95% CI 0.34°–10.83°). Studies in which osteotomies were performed revealed that the angle of correction for PO surgery was comparable to that of AP surgery. Regardless of fixation methods, PO surgical approaches achieved comparable angles.CONCLUSIONSPO surgery using posterior osteotomies can achieve correction of Scheuermann kyphosis as successfully as AP surgery does. Reflecting the advancement of surgical technology, large prospective studies are necessary to identify the proper treatments for Scheuermann kyphosis.

Supine fulcrum bending test and in-cast correction of Scheuermann juvenile kyphosis

<p class="abstract"><strong>Background:</strong> Patients with Scheuermann disease often require conservative management with a series of corrective casts, followed by anti-kyphotic brace. Flexibility of the kyphosis can be assessed during a supine fulcrum bending test. The aim of the study was to analyze the radiological flexibility of kyphosis and immediate in-cast correction in a series of patients conservatively treated.</p><p class="abstract"><strong>Methods:</strong> Eighty-six adolescents were conservatively treated for Scheuermann disease of thoracic location. Charts of 55 patients, 39 boys and 16 girls, were accessible. The mean age was 14.6±1.6 years. On the lateral full-cassette standing radiograph, the angle of thoracic and lumbar lordosis were measured. The flexibility of kyphosis was assessed on a supine fulcrum bending lateral radiograph. The in-cast kyphosis angle was measured on a standing lateral radiograph.<strong></strong></p><p class="abstract"><strong>Results:</strong> In 18 patients, a mild non-progressive scoliotic curvature was present; it did not exceed a Cobb angle measurement of 25°. The initial kyphosis angle was 59.2°±9.3°. The lordosis angle was 76.3°±9.3°. The kyphosis angle on supine fulcrum bending test was 30.4°±9.7°. The kyphosis angle in the reclining cast was 44.3°±12.5°. There was no correlation between age and the supine bending correction. There was a correlation between the correction obtained with the supine bending test and the immediate correction in the cast (r=0.64, p=0.0012).</p><p class="abstract"><strong>Conclusions:</strong> The reduction of the kyphosis Cobb angle by supine fulcrum bending was 50% on average, while in the cast in standing position, only half of this correction was maintained.</p>