Posterior instrumented correction and fusion of Scheuermann´s results in physiological reconstruction of sagittal alignment and excellent overall clinical outcome- clinical trail of 73 patients.

PURPOSE

The aim was to assess the clinical outcomes after posterior spinal fusion (PSF) in patients with Scheuermann's disease (SD).

METHODS

SD undergoing PSF were retrospectively analyzed. Clinical outcome was determined using SRS-22- and Eq. 5D-questionaires preop and after 3, 12, 24 months after surgery. Whole spine x-rays were analyzed (preop, postop, after 6, 12, 24 months): sagittal and coronary Cobb angles, and pelvic parameters were evaluated; ideal lumbar lordosis (LL) was calculated using formula of le Huec (LL = 0.54*PI + 27.6). Surgical time, complications and blood loss were compared. Postop appearance of proximal (PJF) and distal junction failure (DJF) were calculated. Values were given as mean. Comparison with significance α = 0.05.

RESULTS

73 patients were included. SRS-22 total score and EQ5D showed significant increase from preop to two-year FU (each p < 0.001). Preop Thoracic kyphosis (TK) was 75.1° with significant correction to 48.5° (p < 0.001). LL showed mean correction from 68.2° to 46.7° (p < 0.001). Difference between ideal and measured LL showed improvement from - 17.2° preop to -3.3° 6 month postop, good spontaneous correction of hyperlordosis. 63% had < 10° deviation from ideal LL 6 month postoperatively, whereas only 21.4% were in this range preoperatively. No significant changes for spinopelvic parameters during FU. Complications occurred in 13,7% of cases. A low revision rate for PJF (2,7%) was necessary. Subscore mental health showed a correlation to preop TK (p < 0.05).

CONCLUSION

Physiological reconstruction of sagittal alignment could be achieved in most cases (63%). Clinical FU results were convincing with significant improvement of patient's satisfaction. Complication rate was moderate and risk of PJF after PSF low.