Comparison of Anteroposterior to Posterior-Only Correction of Scheuermann's Kyphosis: A Matched-Pair Radiographic Analysis of 92 Patients

Heiko Koller; Lawrence G Lenke; Oliver Meier; Juliane Zenner; Marianne Umschlaeger; Axel Hempfing; Wolfgang Hitzl; Keith H Bridwell; Linda A Koester

doi:10.1016/j.jspd.2014.09.048

Comparison of Anteroposterior to Posterior-Only Correction of Scheuermann's Kyphosis: A Matched-Pair Radiographic Analysis of 92 Patients

Spine Deform. 2015 Mar;3(2):192-198. doi: 10.1016/j.jspd.2014.09.048. Epub 2015 Mar 4.

Authors

Heiko Koller¹, Lawrence G Lenke², Oliver Meier³, Juliane Zenner³, Marianne Umschlaeger³, Axel Hempfing³, Wolfgang Hitzl³, Keith H Bridwell⁴, Linda A Koester⁴

Affiliations

¹ German Scoliosis Center Bad Wildungen, Werner-Wicker Clinic, Im Kreuzfeld 4, D-34537 Bad Wildungen, Germany; Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, A-5020, Salzburg, Austria.
² Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA. Electronic address: lenkel@wudosis.wustl.edu.
³ German Scoliosis Center Bad Wildungen, Werner-Wicker Clinic, Im Kreuzfeld 4, D-34537 Bad Wildungen, Germany.
⁴ Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA.

PMID: 27927312
DOI: 10.1016/j.jspd.2014.09.048

Abstract

Study design: Retrospective radiographic benchmark study.

Objective: To evaluate the amount of instrumented correction obtained from a combined anterior/posterior (A/P) versus posterior-only (post-only) approach for Scheuermann's kyphosis.

Summary of background data: An A/P approach was thought to optimize correction; however, instrumentation advances using pedicle screws allow treatment through an all-posterior approach.

Methods: A total of 166 Scheuermann's kyphosis patients were treated between 2 centers: 90 by combined A/P approach at 1 center and 76 by post-only at the second center. From the 166 patients, a matched cohort of 92 (46 from each) was established according to preoperative sagittal (±10°) and hyperextension (HE) Cobb (±10°) measurements and matched for age and gender.

Results: In the matched-pair group, average preoperative sagittal Cobb angles were 75.9° for the A/P group versus 78.8° for the post-only group (p = .2). The HE Cobb angles were similar (52.4° vs. 51.1°; p = .6). They showed similar corrections (33.7° vs. 30.6°; p = .3) and postoperative Cobb measurements (43.4° vs. 47.1°; p = .2) as well. The number of fusion levels was 9 in the A/P group and 12 in the post-only group; the difference yielded significance (p = .02).

Conclusions: The A/P and post-only approaches averaged similar degrees of correction. The A/P patients were likely to correct more than their preoperative HE sagittal Cobb measurement, whereas the post-only group corrected close to their preoperative HE measurement. The number of fusion levels was larger with the post-only group.

Keywords: Combined anteroposterior procedure; Posterior-only procedure; Radiographic analysis; Scheuermann's kyphosis; Upright and hyperextension sagittal Cobb measurements.