All pedicle screw instrumentation for Scheuermann's kyphosis correction: is it worth it?
BACKGROUND
Scheuermann's kyphosis has long been treated by a two-staged fusion and instrumentation with a hybrid construct using hooks, pedicle screws, and sublaminar wires. Recent interest in all pedicle screw constructs led to its use in the treatment of Scheuermann's kyphosis. Evaluation of this newly described application is needed.


OBJECTIVE
To compare the results of segmental all pedicle screw constructs versus two-staged hybrid instrumentation in patients with Scheuermann's kyphosis analyzing the amount of correction and incidence of complications.


METHODS
Retrospective case series reporting on two groups of patients with Scheuermann's kyphosis treated with single-staged all pedicle screws technique versus two-staged anterior release and posterior hybrid instrumentation followed-up for a minimum of 2 years.


METHODS
The study included 33 patients divided into two groups. The average age was 15 years+9 months and 16 years+8 months, respectively. The average preoperative dorsal kyphosis was 85.5 degrees (Group 1) and 79.8 degrees (Group 2).


METHODS
The deformity was measured by Cobb's method preoperatively, postoperatively, and at final follow-up. Operative time and blood loss were also measured and recorded. The results of the Scoliosis Research Society (SRS)-30 questionnaire were also reviewed.


METHODS
The study included 16 patients who underwent a single-staged correction by segmental all pedicle screw constructs and multiple-level posterior osteotomies (Group 1) and 17 who underwent a two-staged fusion and instrumentation with a hybrid construct (Group 2).


RESULTS
Both groups were followed for a minimum of 2 years. The deformity correction of Group 1 had an average of 52.2% postoperatively with 2.4% loss at final follow-up in comparison to Group 2 where the correction was 48.7% postoperatively with 3.1% loss at final follow-up. The operative time was considerably less in Group 1 with an average of 215 minutes than Group 2 with an average of 315 minutes. The average blood loss was 620cc in Group 1 and 910cc in Group 2. The SRS-30 questionnaire in Group 1 averaged 134 and in Group 2 averaged 120.


CONCLUSIONS
The use of multiple-level all pedicle screws technique allowed a rigid anchor for posterior correction of the deformity with less operative time, blood loss, and hospital stay without the need for anterior release. A better correction was achieved and preserved with the use of all pedicle screw constructs. This technique is a useful modality in the treatment of Scheuermann's kyphosis.
Koptan
Wael M T
WM
Orthopaedic Department, Faculty of Medicine, Cairo University, Geiza, Egypt. waelkoptan@yahoo.com
Elmiligui
Yasser H
YH
Elsebaie
Hazem B
HB
D000293:Adolescent; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery