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 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)
JournalSpine Deformity
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Scheuermann Disease
International Classification of Diseases
Therapeutics
Length of Stay
Demography
Patient Education
Back Pain
Osteotomy
Inpatients
Decision Making
Analysis of Variance
Retrospective Studies
Databases
Weights and Measures

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., ... Passias, P. G. (Accepted/In press). Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012. Spine Deformity. https://doi.org/10.1016/j.jspd.2018.06.004

Trends in Treatment of Scheuermann Kyphosis : A Study of 1,070 Cases From 2003 to 2012. / Horn, Samantha R.; Poorman, Gregory W.; Tishelman, Jared C.; Bortz, Cole A.; Segreto, Frank A.; Moon, John Y.; Zhou, Peter L.; Vaynrub, Max; Vasquez-Montes, Dennis; Beaubrun, Bryan M.; Diebo, Bassel G.; Vira, Shaleen; Raad, Micheal; Sciubba, Daniel; Lafage, Virginie; Schwab, Frank J.; Errico, Thomas J.; Passias, Peter G.

In: Spine Deformity, 01.01.2018.

Research output: Contribution to journalArticle

Horn, SR, Poorman, GW, Tishelman, JC, Bortz, CA, Segreto, FA, Moon, JY, Zhou, PL, Vaynrub, M, Vasquez-Montes, D, Beaubrun, BM, Diebo, BG, Vira, S, Raad, M, Sciubba, D, Lafage, V, Schwab, FJ, Errico, TJ & Passias, PG 2018, 'Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012', Spine Deformity. https://doi.org/10.1016/j.jspd.2018.06.004
Horn, Samantha R. ; Poorman, Gregory W. ; Tishelman, Jared C. ; Bortz, Cole A. ; Segreto, Frank A. ; Moon, John Y. ; Zhou, Peter L. ; Vaynrub, Max ; Vasquez-Montes, Dennis ; Beaubrun, Bryan M. ; Diebo, Bassel G. ; Vira, Shaleen ; Raad, Micheal ; Sciubba, Daniel ; Lafage, Virginie ; Schwab, Frank J. ; Errico, Thomas J. ; Passias, Peter G. / Trends in Treatment of Scheuermann Kyphosis : A Study of 1,070 Cases From 2003 to 2012. In: Spine Deformity. 2018.
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title = "Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012",
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.",
keywords = "Complications, Posterior fusion, Scheuermann kyphosis, Surgical approach, Surgical trends, Trends",
author = "Horn, {Samantha R.} and Poorman, {Gregory W.} and Tishelman, {Jared C.} and Bortz, {Cole A.} and Segreto, {Frank A.} and Moon, {John Y.} and Zhou, {Peter L.} and Max Vaynrub and Dennis Vasquez-Montes and Beaubrun, {Bryan M.} and Diebo, {Bassel G.} and Shaleen Vira and Micheal Raad and Daniel Sciubba and Virginie Lafage and Schwab, {Frank J.} and Errico, {Thomas J.} and Passias, {Peter G.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jspd.2018.06.004",
language = "English (US)",
journal = "Spine Deformity",
issn = "2212-134X",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Trends in Treatment of Scheuermann Kyphosis

T2 - A Study of 1,070 Cases From 2003 to 2012

AU - Horn, Samantha R.

AU - Poorman, Gregory W.

AU - Tishelman, Jared C.

AU - Bortz, Cole A.

AU - Segreto, Frank A.

AU - Moon, John Y.

AU - Zhou, Peter L.

AU - Vaynrub, Max

AU - Vasquez-Montes, Dennis

AU - Beaubrun, Bryan M.

AU - Diebo, Bassel G.

AU - Vira, Shaleen

AU - Raad, Micheal

AU - Sciubba, Daniel

AU - Lafage, Virginie

AU - Schwab, Frank J.

AU - Errico, Thomas J.

AU - Passias, Peter G.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Complications

KW - Posterior fusion

KW - Scheuermann kyphosis

KW - Surgical approach

KW - Surgical trends

KW - Trends

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JO - Spine Deformity

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