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What Are the Indications for Spinal Fusion Surgery in Scheuermann Kyphosis?

Polly, David W. Jr, MD*; Ledonio, Charles G.T., MD*; Diamond, Beverly, PhD; Labelle, Hubert, MD; Sucato, Daniel J., MD, MS§; Hresko, M. Timothy, MD; Emans, John B., MD; Vitale, Michael G., MD; Erickson, Mark A., MD#; Larson, A. Noelle, MD** the Spinal Deformity Study Group

Journal of Pediatric Orthopaedics: May/June 2019 - Volume 39 - Issue 5 - p 217–221
doi: 10.1097/BPO.0000000000000931

Background: Surgical indications for Scheuermann kyphosis are variable. We sought to evaluate the characteristics of patients undergoing operative versus nonoperative treatment of Scheuermann kyphosis to better understand current practices and the factors which contribute to the decision for surgical management.

Methods: Multicenter prospective cohort study. We evaluated consecutive patients presenting with Scheuermann kyphosis. Patients underwent either surgical or nonoperative management according to surgeon and patient discretion. Preoperative patient-reported outcome measures (Scoliosis Research Society and Spinal Appearance Questionnaire scores), demographics, and radiographic characteristics were assessed.

Results: Overall, 150 patients with Scheuermann kyphosis were enrolled, with 77 choosing nonoperative treatment and 73 treated operatively. Compared with the nonoperative cohort, patients treated operatively were older (16.3±2.0 vs. 15.1±2.2, P=0.0004), and had higher body mass index (26.3±7.2 vs. 22.7±6.5, P=0.003), had greater T2-T12 kyphosis (71±14 degrees vs. 61±12 degrees, P<0.001), increased pelvic incidence (46 vs. 41 degrees, P=0.03) and pelvic tilt (10 vs. 3 degrees, P=0.03). There was no detected difference in maximal sagittal Cobb angle in the operative versus nonoperative patients (73±11 vs. 70±12 degrees, P=0.11). Functionally, the operative patients had worse Scoliosis Research Society pain scores (3.7±0.9 vs. 4.1±0.7, P=0.0027) and appearance scores (2.9±0.7 vs. 3.4±0.8, P <0.0001).

Conclusions: Patients undergoing surgical management of Scheuermann disease were more likely to have large body mass index and worse pain scores. Other factors beyond radiographic measurement likely contribute to the decision for surgical management of Scheuermann kyphosis.

Level of Evidence: Level II.

*Department of Orthopaedic Surgery, University of Minnesota, Minneapolis

**Mayo Clinic, Rochester, MN

Edwards Life Sciences, Irvine, CA

St. Justine’s Hospital, Montreal, QC, Canada

§Texas Scottish Rite Hospital for Children, Dallas, TX

Boston Children’s Hospital, Boston, MA

Columbia University, New York, NY

#Children’s Hospital, Aurora, CO

IRB approval was obtained for this study.

No funding was received for this study.

M.A.E.: previous support for travel to meetings from Medtronic, board membership POSNA, payment for lectures from Biomet. A.N.L.: research funding from OREF, SRS, and NIH. C.G.T.L.: research funding from Medtronic, OREF, DOD, SRS. D.W.P: research funding from OREF, DOD; board membership SRS. J.B.E.: board membership J. Children’s Orthopeds; consultancy and royalties—Medtronic, Depuy/Synthes spine. M.T.H.: previous support for travel to meetings from Medtronic and SRS, consultancy Depuy Spine. D.J.S: research funding from Medtronic, board membership SRS, grants from University of Minnesota, POSNA, DOD, Harms Children’s Specialist Foundation, University of Washington at St. Louis, AAOS YOC, OREF; royalties from Tachdjian’s Pediatric Orthopedics, 5th edition. M.G.V: board membership at POSNA, IPOS; consultancy from Stryker, Biomet; research funding from SRS, POSNA, OREF; royalties from Biomet; travel expenses from Children’s Spine Study Group, Fox Study group. Spinal Deformity Study Group: research funding from Medtronic. The remaining authors declare no conflict of interest.

Reprints: David W. Polly Jr, MD, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454. E-mail:

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