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Yuan N, Hu G, Bridwell KH, Koester LA, Lenke LG. How to determine the optimal proximal fusion level for Scheuermann kyphosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1021-1027. [PMID: 37955752 DOI: 10.1007/s00586-023-08029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/23/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To determine optimal proximal fusion levels for instrumented spinal fusion for Scheuermann kyphosis. METHODS We reviewed 86 patients (33 women) who underwent corrective instrumented spinal fusion for Scheuermann kyphosis. All patients had long-cassette upright lateral radiographs taken preoperatively, postoperatively, and at 2 years and the last follow-up. Demographic, radiographic, and surgical parameters were compared between patients with and without PJK. RESULTS PJK occurred in 28 patients (32%). The mean maximum Cobb angle was 85.8° ± 11.7° preoperatively, 54.8° ± 14.2° postoperatively, and 59.7° ± 16.8° at the last follow-up. Age and sex did not differ between the PJK and non-PJK groups (P > 0.05). The preoperative curve characteristics, fusion levels, and corrective ratio were similar in both groups (P > 0.05). The maximal Cobb angle at 2 years and the last follow-up significantly differed between the 2 groups (P < 0.05). The proportion of patients with the uppermost instrumented vertebra (UIV) at or above the proximal end vertebra (PEV) was similar in both groups (P > 0.05). The proportion of patients with UIV at or above T2 was significantly greater in the non-PJK group (P < 0.05). PJK was significantly associated with a C7 plumb line (C7PL)-sacrum distance ≥ 50 mm (P < 0.05). CONCLUSION PJK is the main cause of postoperative correction loss. Proper fusion-level selection can reduce PJK occurrence. We recommend having the UIV at T2 or above, especially when the C7PL-sacrum distance ≥ 50 mm.
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Affiliation(s)
- Ning Yuan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
| | - Guangxun Hu
- Department of Orthopedic Surgery, Shenzhen Nanshan People Hospital, Shenzhen, Guangzhou Province, China
| | - Keith H Bridwell
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Linda A Koester
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University/New York-Presbyterian-Spine Hospital, New York, NY, USA
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O’Donnell JM, Wu W, Youn A, Mann A, Swarup I. Scheuermann Kyphosis: Current Concepts and Management. Curr Rev Musculoskelet Med 2023; 16:521-530. [PMID: 37615931 PMCID: PMC10587050 DOI: 10.1007/s12178-023-09861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW Scheuermann's kyphosis (SK) is a developmental deformity of the spine that affects up to 8% of children in the US. Although, the natural progression of SK is noted to be gradual over years, severe deformity can be associated with significant morbidity. Thorough clinical examination and interpretation of relevant imaging help differentiate and confirm this diagnosis. Treatment includes both operative and nonoperative approaches. The purpose of this article is to provide an updated overview of the current theories of its pathogenesis, as well as the principles of diagnosis and treatment of SK. RECENT FINDINGS Although a definitive, unified theory continues to be elusive, numerous reports in the past decade provide insight into the pathophysiology of SK. These include alterations in mechanical stress and/or hormonal disturbances. Candidate genes have also been identified to be linked to the inheritance of SK. Updates to nonoperative treatment include the effectiveness of dedicated exercise programs, as well as the types and duration of orthotic treatment. Advances in surgical technique can be observed with a trend toward a posterior-only approach, with supporting evidence for careful evaluation of both the sagittal and coronal planes to determine fusion levels in order to avoid postoperative junctional pathologies. SK is an important cause of structural or rigid kyphosis. It can lead to significant morbidity in severe cases. Treatment is based on curve magnitude and symptoms. Nonoperative treatment consists of physical therapy in symptomatic patients, and bracing can be added for skeletally mature patients. Operative management can be considered in patients with large, progressive, and symptomatic deformity. Future studies can benefit from a focused investigation into patient-reported outcomes after undergoing appropriate treatment.
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Affiliation(s)
| | - Wei Wu
- Department of Orthopedic Surgery, UCSF Benioff Children’s Hospital, 747 52nd Street, OPC 1st Floor, Oakland, CA 94609 USA
| | - Alex Youn
- San Francisco School of Medicine, University of California, San Francisco, CA USA
| | - Angad Mann
- California Health Sciences University College of Medicine, Clovis, CA USA
| | - Ishaan Swarup
- Department of Orthopedic Surgery, UCSF Benioff Children’s Hospital, 747 52nd Street, OPC 1st Floor, Oakland, CA 94609 USA
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Eddine HK, Saleh S, Hajjar J, Harati H, Nasser Z, Desoutter A, Al Ahmar E, Estephan E. Evaluation of the accuracy of new modalities in the assessment and classification of lumbar lordosis: A comparison to Cobb's angle measurement. Heliyon 2023; 9:e18952. [PMID: 37600414 PMCID: PMC10432978 DOI: 10.1016/j.heliyon.2023.e18952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background Because of the association of lumbar lordosis with some clinical conditions such as low back pain, the chiropractic field has emphasized the significance of evaluating the lumbar lordotic status, by measuring Cobb's angle, regarded as the radiological gold standard, for the assessment of lumbar lordosis, on lateral radiographs. However, research has shown that this technique has some considerable drawbacks, mostly in terms of low accuracy and high variability between clinicians when compared with other radiological modalities. The main objective was to compare the diagnostic accuracy of newly established radiological measurements with one of Cobb's angle methods, for the characterization of lumbar lordosis status in a sample of Lebanese patients aged 15 and above. Material and methods This retrospective single-center study consisted of measuring Cobb's L1-S1 and Cobb's L1-L5 angles, along with the novel established measurements which are the derivative and the normalized surface area, on 134 lateral radiographs of the lumbar spine of Lebanese patients aged fifteen years old and above, gotten from the Radiology department at Zahra'a's Hospital in Beirut, performed by two observers using MATLAB. Inter-rater agreement was assessed by calculating the Intra-class correlation coefficients. Spearman correlation was analyzed between both Cobb's angle methods and with the derivative and normalized area respectively. 54 patients of the sample were diagnosed by two radiologists, according to their LL status. ROC curve analysis was performed to compare the diagnostic accuracy of the four techniques used. Data were analyzed with IBM SPSS Statistics 23.0 (NY, USA); P < 0.05 was considered statistically significant. Results According to the ROC curve analysis the new methods, which are the derivative and the normalized surface area, displayed lower diagnostic accuracy (AUCderivative = 0.818 and 0.677, AUCsurface area = 0.796 and 0.828) than Cobb's L1-L5 (AUCL1-L5 = 0.924 and 0.929 values) and L1-S1 (AUCL1-S1 = 0.971 and 0.955) angles, in the characterization of hypo and hyperlordotic patients, respectively, in our Lebanese sample consisting of patients aged 15 and above, because of their lower area under the curve's values compared to the traditional Cobb's techniques. The Cobb's L1-S1 has shown to have the highest diagnostic accuracy among the four methods to characterize normal patients from hypo and hyperlordotic ones, by referring to its highest area under the curve's values. However, the sensitivity of Cobb's L1-L5 angle in characterizing hyperlordotic patients was similar to the one of the normalized surface area with a value of 100%.Conclusion: among the four modalities, the new methods didn't show a better diagnostic accuracy compared to the traditional modalities. Cobb's L1-S1 displayed the highest diagnostic accuracy despite its drawbacks. Further prospective studies are needed to validate the cut-offs obtained for Cobb's L1-S1 angle in our sample.
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Affiliation(s)
- Hassane Kheir Eddine
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Sahera Saleh
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Joseph Hajjar
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Hayat Harati
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Zeina Nasser
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Elie Al Ahmar
- School of Engineering, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Elias Estephan
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- LBN, University Montpellier, Montpellier, France
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
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Braun S, Brenneis M, Schönnagel L, Caffard T, Diaremes P. Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients. Life (Basel) 2023; 13:1341. [PMID: 37374124 DOI: 10.3390/life13061341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Scoliosis and Scheuermann's disease are common spinal deformities that affect a substantial population, particularly adolescents, often impacting their quality of life. This comprehensive review aims to present a detailed understanding of these conditions, their diagnosis, and various treatment strategies. Through an extensive exploration of current literature, the review discusses the etiology of these spinal deformities and the use of diagnostic tools such as X-rays and MRI. It further delves into the range of treatment options available, from conservative approaches such as physiotherapy and bracing to more invasive surgical interventions. The review underscores the necessity of an individualized treatment approach, taking into account factors such as the patient's age, the severity of the curvature, and overall health. This all-encompassing perspective on scoliosis and Scheuermann's disease will aid in evidence-based decision making in their management with the goal of improving patient outcomes.
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Affiliation(s)
- Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Lukas Schönnagel
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 10117 Berlin, Germany
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopaedic Surgery, University of Ulm, 89075 Ulm, Germany
| | - Panagiotis Diaremes
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
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Diaremes P, Braun S, Meurer A. [Scheuermann's disease]. DER ORTHOPADE 2022; 51:339-348. [PMID: 35290495 DOI: 10.1007/s00132-022-04239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
Scheuermann's disease represents the second most common deformity of the growing spine after the various forms of scoliosis. In cases of early diagnosis and mild kyphotic deformity conservative treatment with a brace and physiotherapy shows very good results; however, in cases of neurologic deficits, curve progression despite conservative treatment and increasing pain symptoms with a Stagnara angle of more than 70-75°, surgical treatment is meaningful. The surgical strategy can include posterior spondylodesis with prior anterior release or posterior instrumentation with posterior column osteotomy depending on the surgeon's experience. The choice of the extent of the operation with the vertebrae to be instrumented and including the straightening method should be oriented to the avoidance of complications, such as proximal or distal junctional kyphosis.
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Affiliation(s)
- Panagiotis Diaremes
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland.
| | - Sebastian Braun
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland
| | - Andrea Meurer
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland
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