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

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  • 1 Department of Neurosurgery, Seoul National University Hospital;
  • 2 Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital;
  • 3 Department of Neurosurgery, Seoul National University College of Medicine;
  • 4 Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center; and
  • 5 Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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OBJECTIVE

Combined 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.

METHODS

A 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.

RESULTS

Data 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.

CONCLUSIONS

PO 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.

ABBREVIATIONS AP = anterior-posterior; PO = posterior only.

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Contributor Notes

Correspondence Chun Kee Chung: Seoul National University College of Medicine, Seoul, Republic of Korea. chungc@snu.ac.kr.

INCLUDE WHEN CITING Published online December 25, 2020; DOI: 10.3171/2020.7.SPINE201062.

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

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