Contribution of postoperative vertebral remodeling to reversal of vertebral wedging and prevention of correction loss in patients with adolescent Scheuermann’s kyphosis

Sinian Wang MD1, Liang Xu MD1, Muyi Wang MD1, Yong Qiu MD1, Zezhang Zhu MD1, Bin Wang MD1, and Xu Sun MD1
View More View Less
  • 1 Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

OBJECTIVE

This study aimed to investigate reversal of vertebral wedging and to evaluate the contribution of vertebral remodeling to correction maintenance in patients with adolescent Scheuermann’s kyphosis (SK) after posterior-only instrumented correction.

METHODS

A retrospective cohort study of patients with SK was performed. In total, 45 SK patients aged 10–20 years at surgery were included. All patients received at least 24 months of follow-up and had Risser sign greater than grade 4 at latest follow-up. Patients with Risser grade 3 or less at surgery were assigned to the low-Risser group, whereas those with Risser grade 4 or 5 were assigned to the high-Risser group. Radiographic data and patient-reported outcomes were collected preoperatively, immediately postoperatively, and at latest follow-up and compared between the two groups.

RESULTS

Remarkable postoperative correction of global kyphosis was observed, with similar correction rates between the two groups (p = 0.380). However, correction loss was slightly but significantly less in the low-Risser group during follow-up (p < 0.001). The ratio between anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH) of deformed vertebrae notably increased in SK patients from postoperation to latest follow-up (p < 0.05). Loss of correction of global kyphosis was significantly and negatively correlated with increased AVBH/PVBH ratio. Compared with the high-Risser group, the low-Risser group had significantly greater increase in AVBH/PVBH ratio during follow-up (p < 0.05). The two groups had similar preoperative and postoperative Scoliosis Research Society–22 questionnaire scores for all domains.

CONCLUSIONS

Obvious reversal in wedge deformation of vertebrae was observed in adolescent SK patients. Patients with substantial growth potential had greater vertebral remodeling and less correction loss. Structural remodeling of vertebral bodies has a positive effect and protects against correction loss. These results could be help guide treatment decision-making.

ABBREVIATIONS

AVBH = anterior vertebral body height; DWA = disc wedging angle; GK = global kyphosis; LIV = lowermost instrumented vertebra; MDV = most deformed vertebra; PVBH = posterior vertebral body height; SK = Scheuermann’s kyphosis; SRS-22 = Scoliosis Research Society–22 questionnaire; UIV = uppermost instrumented vertebra; VWA = vertebral wedging angle.

Illustration from Rothrock et al. (pp 535–545). Copyright Roberto Suazo. Published with permission.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Scheuermann HW. The classic: kyphosis dorsalis juvenilis.Clin Orthop Relat Res. 1977;(128):57.

  • 2

    Lowe TG, Line BG. Evidence based medicine: analysis of Scheuermann kyphosis. Spine (Phila Pa 1976).2007;32(19)(suppl):S115S119.

  • 3

    Palazzo C, Sailhan F, Revel M. Scheuermann’s disease: an update. Joint Bone Spine. 2014;81(3):209214.

  • 4

    Lowe TG. Scheuermann’s kyphosis. Neurosurg Clin N Am. 2007;18(2):305315.

  • 5

    Lee SS, Lenke LG, Kuklo TR, et al. Comparison of Scheuermann kyphosis correction by posterior-only thoracic pedicle screw fixation versus combined anterior/posterior fusion. Spine (Phila Pa 1976).2006;31(20):23162321.

    • Search Google Scholar
    • Export Citation
  • 6

    Newton PO, Kluck DG, Saito W, et al. Anterior spinal growth tethering for skeletally immature patients with scoliosis: a retrospective look two to four years postoperatively. J Bone Joint Surg Am. 2018;100(19):16911697.

    • Search Google Scholar
    • Export Citation
  • 7

    Faldini C, Traina F, Perna F, et al. Does surgery for Scheuermann kyphosis influence sagittal spinopelvic parameters?. Eur Spine J. 2015;24(suppl 7):893897.

    • Search Google Scholar
    • Export Citation
  • 8

    Jiang L, Qiu Y, Xu L, et al. Sagittal spinopelvic alignment in adolescents associated with Scheuermann’s kyphosis: a comparison with normal population. Eur Spine J. 2014;23(7):14201426.

    • Search Google Scholar
    • Export Citation
  • 9

    Noordeen MH, Haddad FS, Edgar MA, Pringle J. Spinal growth and a histologic evaluation of the Risser grade in idiopathic scoliosis. Spine (Phila Pa 1976).1999;24(6):535538.

    • Search Google Scholar
    • Export Citation
  • 10

    Wang WW, Xia CW, Zhu F, et al. Correlation of Risser sign, radiographs of hand and wrist with the histological grade of iliac crest apophysis in girls with adolescent idiopathic scoliosis. Spine (Phila Pa 1976).2009;34(17):18491854.

    • Search Google Scholar
    • Export Citation
  • 11

    Zhu Z, Tang NL, Xu L, et al. Genome-wide association study identifies new susceptibility loci for adolescent idiopathic scoliosis in Chinese girls. Nat Commun. 2015;6:8355.

    • Search Google Scholar
    • Export Citation
  • 12

    Geck MJ, Macagno A, Ponte A, Shufflebarger HL. The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech. 2007;20(8):586593.

    • Search Google Scholar
    • Export Citation
  • 13

    Zhu ZZ, Chen X, Qiu Y, et al. Adding satellite rods to standard two-rod construct with the use of duet screws: an effective technique to improve surgical outcomes and preventing proximal junctional kyphosis in posterior-only correction of Scheuermann kyphosis. Spine (Phila Pa 1976).2018;43(13):E758E765.

    • Search Google Scholar
    • Export Citation
  • 14

    Xu L, Shi B, Qiu Y, et al. How does the cervical spine respond to hyperkyphosis correction in Scheuermann’s disease?. J Neurosurg Spine. 2019;31(4):493500.

    • Search Google Scholar
    • Export Citation
  • 15

    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(9):15291539.

    • Search Google Scholar
    • Export Citation
  • 16

    Goh S, Price RI, Leedman PJ, Singer KP. A comparison of three methods for measuring thoracic kyphosis: implications for clinical studies. Rheumatology (Oxford). 2000;39(3):310315.

    • Search Google Scholar
    • Export Citation
  • 17

    Manns RA, Haddaway MJ, McCall IW, et al. The relative contribution of disc and vertebral morphometry to the angle of kyphosis in asymptomatic subjects. Clin Radiol. 1996;51(4):258262.

    • Search Google Scholar
    • Export Citation
  • 18

    Goh S, Price RI, Leedman PJ, Singer KP. The relative influence of vertebral body and intervertebral disc shape on thoracic kyphosis. Clin Biomech (Bristol, Avon). 1999;14(7):439448.

    • Search Google Scholar
    • Export Citation
  • 19

    Koller H, Juliane Z, Umstaetter M, et al. Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases. Eur Spine J. 2014;23(1):180191.

    • Search Google Scholar
    • Export Citation
  • 20

    Tsutsui S, Pawelek JB, Bastrom TP, et al. Do discs “open” anteriorly with posterior-only correction of Scheuermann’s kyphosis?. Spine (Phila Pa 1976).2011;36(16):E1086E1092.

    • Search Google Scholar
    • Export Citation
  • 21

    Akyuz E, Braun JT, Brown NA, Bachus KN. Static versus dynamic loading in the mechanical modulation of vertebral growth. Spine (Phila Pa 1976).2006;31(25):E952E958.

    • Search Google Scholar
    • Export Citation
  • 22

    Braun JT, Hoffman M, Akyuz E, et al. Mechanical modulation of vertebral growth in the fusionless treatment of progressive scoliosis in an experimental model. Spine (Phila Pa 1976).2006;31(12):13141320.

    • Search Google Scholar
    • Export Citation
  • 23

    Braun JT, Hines JL, Akyuz E, et al. Relative versus absolute modulation of growth in the fusionless treatment of experimental scoliosis. Spine (Phila Pa 1976).2006;31(16):17761782.

    • Search Google Scholar
    • Export Citation
  • 24

    Mente PL, Aronsson DD, Stokes IA, Iatridis JC. Mechanical modulation of growth for the correction of vertebral wedge deformities. J Orthop Res. 1999;17(4):518524.

    • Search Google Scholar
    • Export Citation
  • 25

    Harrington PR. Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am. 1962;44-A:591610.

    • Search Google Scholar
    • Export Citation
  • 26

    Moe JH. Modern concepts of treatment of spinal deformities in children and adults. Clin Orthop Relat Res. 1980;(150):137153.

  • 27

    Olgun ZD, Ahmadiadli H, Alanay A, Yazici M. Vertebral body growth during growing rod instrumentation: growth preservation or stimulation?. J Pediatr Orthop. 2012;32(2):184189.

    • Search Google Scholar
    • Export Citation
  • 28

    Ahmad AA, Aker L, Hanbali Y, et al. Growth modulation and remodeling by means of posterior tethering technique for correction of early-onset scoliosis with thoracolumbar kyphosis. Eur Spine J. 2017;26(6):17481755.

    • Search Google Scholar
    • Export Citation
  • 29

    Mehlman CT, Araghi A, Roy DR. Hyphenated history: the Hueter-Volkmann law. Am J Orthop. 1997;26(11):798800.

  • 30

    Wang S, Qiu Y, Ma Z, et al. Histologic, Risser sign, and digital skeletal age evaluation for residual spine growth potential in Chinese female idiopathic scoliosis. Spine (Phila Pa 1976).2007;32(15):16481654.

    • Search Google Scholar
    • Export Citation
  • 31

    Scoles PV, Latimer BM, DiGiovanni BF, et al. Vertebral alterations in Scheuermann’s kyphosis. Spine (Phila Pa 1976).1991;16(5):509515.

  • 32

    Ponte A, Orlando G, Siccardi GL. The true Ponte osteotomy: by the one who developed it. Spine Deform. 2018;6(1):211.

  • 33

    Böhm H, Harms J, Donk R, Zielke K. Correction and stabilization of angular kyphosis. Clin Orthop Relat Res. 1990;(258):5661.

  • 34

    Tribus CB. Scheuermann’s kyphosis in adolescents and adults: diagnosis and management. J Am Acad Orthop Surg. 1998;6(1):3643.

  • 35

    Marty C, Boisaubert B, Descamps H, et al. The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients. Eur Spine J. 2002;11(2):119125.

    • Search Google Scholar
    • Export Citation
  • 36

    Wang SF, Qiu Y, Zhu ZZ, et al. Assessment of the residual spine growth potential in idiopathic scoliosis by Risser sign and histological grading. Article in Chinese. Zhonghua Yi Xue Za Zhi. 2008;88(7):461464.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 44 44 44
Full Text Views 12 12 12
PDF Downloads 16 16 16
EPUB Downloads 0 0 0