Department of Orthopedic Surgery, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan.
Department of Public Health, Medical School, Jordan University of Science and Technology, Irbid, Jordan.
Clin Orthop Surg. 2022 Jun;14(2):244-252. doi: 10.4055/cios20219. Epub 2022 Mar 3.
Scheuermann's disease is the most common cause of hyperkyphosis of the thoracic spine during the adolescence period. It causes neck and lower back pain, restriction of lung expansion, traction of the spinal cord, increased vulnerability to vertebral fracture, and a hump. Patients with curves < 60° are treated conservatively, while surgery is used for patients with curves > 60°. The purpose of this prospective cohort study was to assess the quality of life and functional changes in conservatively or surgically treated Scheuermann's disease patients with a curve size of 50°-65° in north Jordan.
Sixty-three adolescent patients with Scheuermann's kyphosis (aged between 10 and 18 years) were treated at our hospital between January 2014 and August 2018. All patients were investigated clinically, radiologically (Cobb's angle), and functionally (Oswestry Disability Index [ODI], Scoliosis Research Society 22 revision [SRS-22r] questionnaire, and pulmonary function test [PFT]) pre- and post-treatment (final follow-up). Patients were randomly selected for treatment method (conservative versus surgical).
There were 31 patients (mean age, 15.48 ± 2.50 years) and 32 patients (mean age, 16.19 ± 1.51 years) treated conservatively and surgically, respectively. Mean ± standard deviation of ODI, SRS-22r, and Cobb's angle of the surgical group improved from 16.8% ± 14.3%, 3.5 ± 0.5, and 58.75° ± 3.59°, respectively, pre-surgery to 13.4% ± 10.8%, 4.2 ± 0.5, and 41.53° ± 3.94°, respectively, post-surgery, while those of the conservative group became worse from 12.6% ± 13.4%, 3.9 ± 0.7, and 56.1° ± 3.3°, respectively, to 20.1% ± 13.6%, 3.5 ± 0.7, and 58.8° ± 5.8°, respectively. The surgical group showed better improvement in all scores than the conservative group ( < 0.05), as well as in PFT.
Surgical treatment of Scheuermann's kyphosis with curves of 50°-65° resulted in better QOL, Cobb's angle, and PFT than conservative treatment. This was because of lower patient cooperation in the conservative management group, which made the curve less flexible for exercises and bracing.
Scheuermann 病是青少年时期胸段脊柱后凸最常见的原因。它会导致颈部和下背部疼痛、肺扩张受限、脊髓牵拉、椎体骨折易感性增加以及形成驼背。曲线<60°的患者采用保守治疗，而曲线>60°的患者则采用手术治疗。本前瞻性队列研究的目的是评估在约旦北部，对 50°-65°的 Scheuermann 病患者进行保守或手术治疗后，患者生活质量和功能变化情况。
2014 年 1 月至 2018 年 8 月期间，我院对 63 例患有 Scheuermann 后凸畸形的青少年患者（年龄在 10-18 岁之间）进行了治疗。所有患者均进行了临床、影像学（Cobb 角）和功能（Oswestry 残疾指数[ODI]、脊柱侧凸研究协会 22 修订版[SRS-22r]问卷和肺功能测试[PFT]）检查。在治疗前（最终随访时）和治疗后对患者进行了评估。患者随机选择治疗方法（保守治疗与手术治疗）。
分别有 31 例（平均年龄 15.48±2.50 岁）和 32 例（平均年龄 16.19±1.51 岁）患者接受了保守和手术治疗。手术组的 ODI、SRS-22r 和 Cobb 角的平均标准差分别从术前的 16.8%±14.3%、3.5±0.5 和 58.75°±3.59°改善至术后的 13.4%±10.8%、4.2±0.5 和 41.53°±3.94°，而保守组则从术前的 12.6%±13.4%、3.9±0.7 和 56.1°±3.3°恶化至术后的 20.1%±13.6%、3.5±0.7 和 58.8°±5.8°。手术组在所有评分上的改善均优于保守组（<0.05），PFT 也是如此。
对于 50°-65°的 Scheuermann 后凸畸形患者，手术治疗比保守治疗更能提高生活质量、改善 Cobb 角和肺功能。这是因为保守治疗组患者的配合度较低，导致运动和支具治疗时曲线的灵活性降低。
