Correction of adolescent hyperkyphosis with posterior-only threaded rod compression instrumentation: is anterior spinal fusion still necessary?
METHODS
Retrospective clinical and radiographic review.


OBJECTIVE
To assess the need for anterior apical release and fusion before posterior threaded rod compression instrumentation and closing-wedge lamina resection for the treatment of adolescent hyperkyphosis.


BACKGROUND
Traditional treatment of adolescent hyperkyphosis has included a preliminary anterior release and fusion of apical disc segments to achieve and maintain better correction.


METHODS
A total of 27 patients undergoing correction of adolescent hyperkyphosis with posterior threaded rod Texas Scottish Rite Hospital instrumentation was reviewed. Of the 27 patients, 19 had strict Sorensen criteria for Scheuermann kyphosis. There were 20 patients (group 1) who underwent posterior surgery only, while 7 (group 2) underwent same day preliminary open or endoscopic anterior release and fusion of 5-7 apical segments. A closing-wedge laminar resection was used to facilitate shortening of the posterior column. All but 2 patients were braced for up to 3 months after surgery. Preoperative, immediate postoperative, and final follow-up radiographs at 24-56 months postoperatively were analyzed for the amount and loss of correction of measured kyphosis, T2-T12 kyphosis, T10-L2 kyphosis, T12-S1 lordosis, C7 plumbline sagittal balance, and correction of Voutsinas index.


RESULTS
There was no difference in the amount of correction achieved at final follow-up between the 2 groups (group 1 = 53%, group 2 = 46%, P = 0.47). There was also no difference (P = 0.84) in the amount of correction immediately after surgery compared to final follow-up. No patient lost more than 8 degrees correction after surgery. One asymptomatic rod fracture occurred, with no loss of correction, implying no pseudarthroses. Similarly, there were no differences in any of the other sagittal plane measurements between the 2 groups, except for Voutsinas index (VI) in which group 1 patients had better normalization (VI = 0.11) compared to group 2 (VI = 0.15, P =0.05).


CONCLUSIONS
Traditional anterior/posterior fusion technique provides no additional improvement in radiographic outcome compared to posterior-only surgery for adolescent hyperkyphosis. Preliminary anterior release and fusion is no longer performed when correcting this deformity with a posterior column shortening procedure and threaded rod compression instrumentation.
Johnston
Charles E
CE
Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA. charles.johnston@tsrh.org
Elerson
Emily
E
Dagher
Georges
G
D000293:Adolescent; D000328:Adult; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome