Skip to main content
NCBI home page
Springer Nature - PMC COVID-19 Collection logoLink to Springer Nature - PMC COVID-19 Collection
. 2019 Dec 30;7(1):100–106. doi: 10.1016/j.jspd.2018.06.004

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

Samantha R Horn 1, Gregory W Poorman 1, Jared C Tishelman 1, Cole A Bortz 1, Frank A Segreto 1, John Y Moon 1, Peter L Zhou 1, Max Vaynrub 1, Dennis Vasquez-Montes 1, Bryan M Beaubrun 1, Bassel G Diebo 2, Shaleen Vira 1, Micheal Raad 3, Daniel M Sciubba 3, Virginie Lafage 4, Frank J Schwab 4, Thomas J Errico 1, Peter G Passias 1,✉
PMCID: PMC7102192  PMID: 30587300

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: Scheuermann kyphosis, Trends, Complications, Surgical trends, Posterior fusion, Surgical approach

Footnotes

Author disclosures: SRH (none), GWP (none), JCT (none), CAB (none), FAS (none), JYM (none), PLZ (none), MV (none), DVM (none), BMB (none), BGD (none), SV (none), MR (none), DMS (none), VL (personal fees from DePuy Synthes, NuVasive, K2M, and Medtronic; other from Nemaris, outside the submitted work), FJS (grants from DePuy Synthes and SRS; personal fees from Zimmer Biomet, NuVasive, K2M, MSD, and Medicrea; other from Nemaris INC, outside the submitted work), TJE (none), PGP (personal fees from Medicrea and SpineWave; nonfinancial support from Zimmer-Biomet and Allosource; grants from CSRS, outside the submitted work).

IRB approval: Exempt—being a study of NIS, which is publicly available and does not contain any patient-identifying information.

Funding information: No sources of funding.

References

  • [1].Greene TL, Hensinger RN, Hunter LY. Back pain and vertebral changes simulating Scheuermann’s disease. J Pediatr Orthop. 1985;5:1–7. doi: 10.1097/01241398-198501000-00001. [DOI] [PubMed] [Google Scholar]
  • [2].Ali RM, Green DW, Patel TC. Scheuermann’s kyphosis. Curr Opin Pediatr. 1999;11:70–5. doi: 10.1097/00008480-199902000-00014. [DOI] [PubMed] [Google Scholar]
  • [3].Cleveland RH, Delong GR. The relationship of juvenile lumbar disc disease and Scheuermann’s disease. Pediatr Radiol. 1981;10:161–4. doi: 10.1007/BF00975191. [DOI] [PubMed] [Google Scholar]
  • [4].Paajanen H, Alanen A, Erkintalo M, et al. Disc degeneration in Scheuermann disease. Skelet Radiol. 1989;18:523–6. doi: 10.1007/BF00351753. [DOI] [PubMed] [Google Scholar]
  • [5].Lowe TG. Scheuermann’s kyphosis. Neurosurg Clin N Am. 2007;18:305–15. doi: 10.1016/j.nec.2007.02.011. [DOI] [PubMed] [Google Scholar]
  • [6].Scheuermann HW. Kyfosis dorsalis juvenalis. Ugeskr Laeger. 1920;82:385–93. [Google Scholar]
  • [7].Sorensen KH. Scheuermann’s juvenile kyphosis: clinical apperances, radiography, etiology and prognosis. Ann Arbor, MI: Munksgaard; 1964. [Google Scholar]
  • [8].Lowe TG. Scheuermann disease. J Bone Joint Surg Am. 1990;72:940–5. doi: 10.2106/00004623-199072060-00026. [DOI] [PubMed] [Google Scholar]
  • [9].Blumenthal SL, Roach J, Herring JA. Lumbar Scheuermann’s. A clinical series and classification. Spine (Phila Pa 1976) 1987;12:929–32. doi: 10.1097/00007632-198711000-00015. [DOI] [PubMed] [Google Scholar]
  • [10].Damborg F, Engell V, Andersen M, et al. Prevalence, concordance, and heritability of Scheuermann kyphosis based on a study of twins. J Bone Joint Surg Am. 2006;88:2133–6. doi: 10.2106/JBJS.E.01302. [DOI] [PubMed] [Google Scholar]
  • [11].Temponi EF, de Macedo RD, Pedrosa LOG, Fontes BPC. Scheuermann’s kyphosis: comparison between the posterior approach associated with Smith-Petersen osteotomy and combined anterior-posterior fusion. Rev Bras Ortop. 2011;46:709–17. doi: 10.1590/S0102-36162011000600014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [12].Scoles PV, Latimer BM, DigIovanni BF, et al. Vertebral alterations in Scheuermann’s kyphosis. Spine (Phila Pa 1976) 1991;16:509–15. doi: 10.1097/00007632-199105000-00004. [DOI] [PubMed] [Google Scholar]
  • [13].Papagelopoulos PJ, Mavrogenis AF, Savvidou OD, et al. Current concepts in Scheuermann’s kyphosis. Orthopedics. 2008;31:52–60. doi: 10.3928/01477447-20080101-33. [DOI] [PubMed] [Google Scholar]
  • [14].Hart ES, Merlin G, Harisiades J, Grottkau BE. Scheuermann’s thoracic kyphosis in the adolescent patient. Orthop Nurs. 2010;29:363–5. doi: 10.1097/NOR.0b013e3181fb9ab6. [DOI] [PubMed] [Google Scholar]
  • [15].Tribus CB. Scheuermann’s kyphosis in adolescents and adults: diagnosis and management. J Am Acad Orthop Surg. 1998;6:36–43. doi: 10.5435/00124635-199801000-00004. [DOI] [PubMed] [Google Scholar]
  • [16].Ferguson ABJ. The etiology of preadolescent kyphosis. J Bone Joint Surg Am. 1956;38–A:149–57. doi: 10.2106/00004623-195638010-00017. [DOI] [PubMed] [Google Scholar]
  • [17].Bowen RE, Abel MF, Arlet V, et al. Outcome assessment in neuromuscular spinal deformity. J Pediatr Orthop. 2012;32:792–8. doi: 10.1097/BPO.0b013e318273ab5a. [DOI] [PubMed] [Google Scholar]
  • [18].Lee SS, Lenke LG, Kuklo TR, et al. Comparison of Scheuermann kyphosis correction by posterior-only thoracic pedicle screw fixation versus combined anterior/posterior fusion. Spine (Phila Pa 1976) 2006;31:2316–21. doi: 10.1097/01.brs.0000238977.36165.b8. [DOI] [PubMed] [Google Scholar]
  • [19].Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976) 2006;31:S171–8. doi: 10.1097/01.brs.0000231963.72810.38. [DOI] [PubMed] [Google Scholar]
  • [20].Jain A, Sponseller PD, Kebaish KM, Mesfin A. National trends in spinal fusion surgery for Scheuermann kyphosis. Spine Deform. 2015;3:52–6. doi: 10.1016/j.jspd.2014.06.009. [DOI] [PubMed] [Google Scholar]
  • [21].Taylor CA, Greenspan AI, Xu L, Kresnow MJ. Comparability of national estimates for traumatic brain injury-related medical encounters. J Head Trauma Rehabil. 2015;30:150–9. doi: 10.1097/HTR.0000000000000105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [22].Healthcare Cost and Utlization Project (HCUP). Introduction to the HCUP National Inpatient Sample (NIS) 2013, https://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2013.jsp. Accessed February 18, 2016.
  • [23].Suh SW, Modi HN, Yang JH, Hong JY. Idiopathic scoliosis in Korean schoolchildren: a prospective screening study of over 1 million children. Eur Spine J. 2011;20:1087–94. doi: 10.1007/s00586-011-1695-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [24].Wong HK, Hui JHP, Rajan U, Chia HP. Idiopathic scoliosis in Singapore schoolchildren: a prevalence study 15 years into the screening program. Spine (Phila Pa 1976) 2005;30:1188–96. doi: 10.1097/01.brs.0000162280.95076.bb. [DOI] [PubMed] [Google Scholar]
  • [25].Soucacos PN, Soucacos PK, Zacharis KC, et al. School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece. J Bone Joint Surg Am. 1997;79:1498–503. doi: 10.2106/00004623-199710000-00006. [DOI] [PubMed] [Google Scholar]
  • [26].Korovessis P, Zacharatos S, Koureas G, Megas P. Comparative multifactorial analysis of the effects of idiopathic adolescent scoliosis and Scheuermann kyphosis on the self-perceived health status of adolescents treated with brace. Eur Spine J. 2007;16:537–46. doi: 10.1007/s00586-006-0214-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [27].Myers BA, Friedman SB, Weiner IB. Coping with a chronic disability. Psychosocial observations of girls with scoliosis treated with the Milwaukee brace. Am J Dis Child. 1970;120:175–81. doi: 10.1001/archpedi.1970.02100080059001. [DOI] [PubMed] [Google Scholar]
  • [28].Sapountzi-Krepia DS, Valavanis J, Panteleakis GP, et al. Perceptions of body image, happiness and satisfaction in adolescents wearing a Boston brace for scoliosis treatment. J Adv Nurs. 2001;35:683–90. doi: 10.1046/j.1365-2648.2001.01900.x. [DOI] [PubMed] [Google Scholar]
  • [29].Campbell RM. Spine deformities in rare congenital syndromes: clinical issues. Spine (Phila Pa 1976) 2009;34:1815–27. doi: 10.1097/BRS.0b013e3181ab64e9. [DOI] [PubMed] [Google Scholar]
  • [30].Dietz HC, et al. Marfan syndrome. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® [Internet] Seattle, WA: University of Washington; 1993. [Google Scholar]
  • [31].Jones KB, Sponseller PD, Hobbs W, Pyeritz RE. Leg-length discrepancy and scoliosis in Marfan syndrome. J Pediatr Orthop. 2002;22:807–12. [PubMed] [Google Scholar]
  • [32].Abdalla EM, Rohrbach M, Burer C, et al. Kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VIA) in six Egyptian patients presenting with a homogeneous clinical phenotype. Eur J Pediatr. 2015;174:105–12. doi: 10.1007/s00431-014-2429-9. [DOI] [PubMed] [Google Scholar]
  • [33].Johnston CE, 2nd, Elerson E, Dagher G. Correction of adolescent hyperkyphosis with posterior-only threaded rod compression instrumentation: is anterior spinal fusion still necessary? Spine (Phila Pa 1976) 2005;30:1528–34. doi: 10.1097/01.brs.0000167672.06216.73. [DOI] [PubMed] [Google Scholar]
  • [34].Koller H, Juliane Z, Umstaetter M, et al. Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases. Eur Spine J. 2014;23:180–91. doi: 10.1007/s00586-013-2894-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [35].Denis F, Sun EC, Winter RB. Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spine (Phila Pa 1976) 2009;34:E729–34. doi: 10.1097/BRS.0b013e3181ae2ab2. [DOI] [PubMed] [Google Scholar]
  • [36].Lonner BS, Newton P, Betz R, et al. Operative management of Scheuermann’s kyphosis in 78 patients: radiographic outcomes, complications, and technique. Spine (Phila Pa 1976) 2007;32:2644–52. doi: 10.1097/BRS.0b013e31815a5238. [DOI] [PubMed] [Google Scholar]

Articles from Spine Deformity are provided here courtesy of Nature Publishing Group

RESOURCES