INTRODUCTION: Several surgical strategies have been reported in literature for correcting a Scheuermann's hyper‐kyphotic deformity. We have compared the radiological and clinical outcomes following three different techniques based on the need and efficacy of anterior surgery.
METHODS: Twenty three patients underwent an instrumented correction of the thoracic kyphosis by posterior segmental instrumentation T2 to L2/3 with multi‐level apical chevron osteotomies. These were divided into 3 matched groups (age, sex and BMI). Group A (8 patients): Posterior + anterior morselized rib graft. Group B (7 patients): Posterior + anterior titanium interbody cages. Group C (8 patients): Posterior alone. Outcomes assessed: Cobb angle, sagittal vertical axis, sacral inclination and lumbar lordosis, Oswestry Disability Index, Visual Analogue Scale and SRS‐22. The assessments were preoperative, postoperative and at final follow‐up (70 mo: group A; 66 mo: group B; 35 mo: group C).
RESULTS: The Cobb angle was corrected from 88.4° to 42° and 42.0°. The SVA improved from +3.5 cms to ‐1.5 cms and +1 cm. The lumbar lordosis improved from 66° to 45° and 42.0°. The median sacral inclination angle changed from 40° to 30° and 22.0°. A significant difference was noted between the pre and the post, but not between the post and the final. There was no significant difference obtained in the final Cobb angle between the 3 groups. The improvements in ODI and SRS‐22 scores were similar between the three groups.
DISCUSSION: The correction of global sagittal balance, compensatory lumbar lordosis and the sacral inclination were similar in all the groups and well maintained to the last assessment. Addition of an anterior procedure does not reflect in an improved correction. Hence we conclude that a single stage posterior segmental instrumentation is sufficient.