Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012

Samantha R. Horn, Gregory W. Poorman, Jared C. Tishelman, Cole A. Bortz, Frank A. Segreto, John Y. Moon, Peter L. Zhou, Max Vaynrub, Dennis Vasquez-Montes, Bryan M. Beaubrun, Bassel G. Diebo, Shaleen Vira, Micheal Raad, Daniel M. Sciubba, Virginie Lafage, Frank J. Schwab, Thomas J. Errico, Peter G. Passias

Research output: Contribution to journalArticle

Abstract

Study Design: Retrospective review of KID Inpatient Database (KID) from 2003, 2006, 2009, and 2012. Objectives: The aim of this study was to evaluate the impact of advances in spinal surgery on patient outcomes in the treatment of Scheuermann kyphosis (SK). Summary of Background Data: SK is one of the most common causes of back pain in adolescents. Trends in diagnoses and surgical treatment and approach to SK have not been well described. Methods: SK patients aged 0–20 years in KID were identified by ICD-9 code 732.0. KID-supplied year- and hospital-trend weights were used to establish prevalence. Patient demographics, surgical details, and outcomes were analyzed with analysis of variance. Results: A total of 1,070 SK patients were identified (33.2% female), with increasing incidence of SK diagnosed from 2003 to 2012 (3.6–7.5 per 100,000, p <.001). The average age of operative patients was 16.1±2.0 years and did not change (16.27–16.06 years, p =.905). The surgical rate has not changed over time (72.8%–72.8%, p =.909). Overall, 96.3% of operative patients underwent fusion, with 82.2% of cases spanning ≥4 levels; in addition, 8.6% underwent an anterior-only surgery, 74.6% posterior-only, and 13.6% combined approach. From 2003 to 2012, rates of posterior-only surgeries increased (62.4%–84.4%, p <.001) whereas the rate of combined-approach surgeries decreased (37.6%–8.8%, p <.001). Overall complication rates for SK surgeries have decreased (2003: 20.9%; 2012: 11.9%, p =.029). Concurrently, the rate of ≥4-level fusions has increased (43.5%–89.6%, p <.001), as well as the use of Smith-Peterson (7.8%–23.6%, p <.001) and three-column osteotomies (0.0%–2.7%, p =.011). In subanalysis comparing posterior to combined approaches, complication rates were significantly different (posterior: 9.88%, combined: 19.46%, p =.005). Patients undergoing a combined approach have a longer length of stay (LOS) than patients undergoing a posterior-only approach (7.8 vs. 5.6 days, p <.001). Conclusions: Despite unchanged demographics and operative rates in SK, there has been a shift from combined to isolated posterior approaches, with a concurrent increase in levels treated. A combined approach was associated with increased complication rates, LOS, and total charges compared to isolated approaches. Awareness of these inherent differences is important for surgical decision making and patient education. Levels of Evidence: Level III.

Original languageEnglish (US)
Pages (from-to)100-106
Number of pages7
JournalSpine deformity
Volume7
Issue number1
DOIs
StatePublished - Jan 2019

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Keywords

  • Complications
  • Posterior fusion
  • Scheuermann kyphosis
  • Surgical approach
  • Surgical trends
  • Trends

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Horn, S. R., Poorman, G. W., Tishelman, J. C., Bortz, C. A., Segreto, F. A., Moon, J. Y., Zhou, P. L., Vaynrub, M., Vasquez-Montes, D., Beaubrun, B. M., Diebo, B. G., Vira, S., Raad, M., Sciubba, D. M., Lafage, V., Schwab, F. J., Errico, T. J., & Passias, P. G. (2019). Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012. Spine deformity, 7(1), 100-106. https://doi.org/10.1016/j.jspd.2018.06.004