How does the cervical spine respond to hyperkyphosis correction in Scheuermann’s disease?

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OBJECTIVE

This study aimed to quantify the response of the cervical spine to the surgical correction of Scheuermann’s kyphosis (SK) and to postoperative proximal junctional kyphosis (PJK).

METHODS

Fifty-nine patients (mean age 14.6 ± 2.3 years) were enrolled in the study: 35 patients in a thoracic SK (T-SK) group and 24 in a thoracolumbar SK (TL-SK) group. The mean follow-up period was 47.2 ± 17.6 months. Radiographic data, PJK-related complications, and patient-reported outcomes were compared between groups.

RESULTS

The global kyphosis significantly decreased postoperatively, and similar correction rates were observed between the two groups (mean 47.1% ± 8.6% [T-SK] vs 45.8% ± 9.4% [TL-SK], p = 0.585). The cervical lordosis (CL) in the T-SK group notably decreased from 21.4° ± 13.3° to 13.1° ± 12.4° after surgery and was maintained at 14.9° ± 10.7° at the latest follow-up, whereas in the TL-SK group, CL considerably increased from 7.2° ± 10.7° to 11.7° ± 11.1° after surgery and to 13.8° ± 8.9° at the latest follow-up. PJK was identified in 16 patients (27.1%). Its incidence in the TL-SK group was notably higher than it was in the T-SK group (41.6% [n = 10] vs 17.1% [n = 6], p = 0.037). Compared with non-PJK patients, PJK patients had greater CL and lower pain scores on the Scoliosis Research Society–22 questionnaire (p < 0.05).

CONCLUSIONS

Hyperkyphosis correction eventually resulted in reciprocal changes in the cervical spine, with CL notably decreased in the T-SK group but significantly increased in the TL-SK group. Patients developing PJK have increased CL, which seems to have a negative effect on patients’ health-related quality of life.

ABBREVIATIONS CL = cervical lordosis; C-SVA = cervical sagittal vertical axis; GK = global kyphosis; LIV = lowermost instrumented vertebra; PJK = proximal junctional kyphosis; SK = Scheuermann’s kyphosis; SRS-22 = Scoliosis Research Society–22 questionnaire; SVA = sagittal vertical axis; T-SK = thoracic SK; TK = thoracic kyphosis; TL-SK = thoracolumbar SK; UIV = uppermost instrumented vertebra.

Article Information

Correspondence Xu Sun: Drum Tower Hospital, Nanjing University Medical School, Nanjing, China. drsunxu@163.com.

INCLUDE WHEN CITING Published online June 7, 2019; DOI: 10.3171/2019.3.SPINE1916.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    A: A 14-year-old girl with T-SK (apex located at T7) underwent posterior-only multilevel Ponte osteotomies from T6 to L1 and pedicle screw instrumentation and fusion from T2 to L2. B: Her GK was remarkably corrected postoperatively, and her CL also decreased after the GK correction. C: Throughout 52 months of follow-up, the patient’s GK and CL remained steady.

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    A: A 13-year-old boy with TL-SK (apex located at T11) underwent posterior-only multilevel Ponte osteotomies from T10 to L2 and pedicle screw instrumentation and fusion from T5 to L3. B: His GK was remarkably corrected postoperatively, and his CL also decreased after the GK correction. C: Throughout 46 months of follow-up, his GK slightly increased and PJK was diagnosed with a proximal junctional angle of 20°. Meanwhile, his CL also increased from 19° to 25°.

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