title: Comparison of Scheuermann's kyphosis correction by combined anterior-posterior fusion versus posterior-only procedure.
abstract: Conventional treatment of rigid deformity in Scheuermann's kyphosis (SK) in young patients includes a preliminary anterior spinal release and fusion (ASF) followed by posterior spinal fusion and instrumentation (PSF). However, recently there are more trends to do posterior-only surgery for correction of this deformity. The aim of our study was to compare clinical and radiological outcomes of ASF/PSF and PSF-only procedures in treatment of SK.
  
  
  
  In a prospective clinical and radiological review, thirty operated SK patients in two groups were evaluated. Group A: ASF/PSF technique (n: 16) and group B: PSF-only procedure (n: 14) were followed for at least 2 years (average 57.6 months). Two groups were well matched for the following four criteria: average age, flexibility status, posterior fusion levels, and preoperative Cobb's kyphosis angle. Oswestry disability index (ODI) and scoliosis research society questionnaire-30 (SRS-30) and radiological (kyphosis correction, correction loss, sagittal balance) parameters were evaluated before and after surgery and at the final follow-up.
  
  
  
  In group A, primary thoracic Cobb's kyphosis, immediate post-operative kyphosis, and final follow-up kyphosis angle were 83.6°, 41.4° and 43°, respectively (P < 0.05). Correction rate and correction loss were 50.5 % and 1.6° ± 2.4, respectively. In group B, the corresponding values were 81.9°, 40.1° and 43.2°, respectively (P < 0.05). Correction rate and correction loss were 51 % and 3.1° ± 2.5, respectively. SRS-30 and ODI scores in group A were averaged 68.5 and 21.3 preoperatively and 128.7 and 6.25 at the final follow-up, respectively. In group B, the corresponding values were 64 and 23.2 preoperatively and 133.5 and 5.8 at the final follow-up, respectively.
  
  
  
  Clinical and radiological parameters were similar in both groups after surgical correction while, complication rates, operation time and blood loss were significantly higher in ASF/PSF procedure.
authors.affiliation: Department of Orthopedic Spinal Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Etemadifar
authors.affiliation: Department of Orthopedic Spinal Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Ebrahimzadeh
authors.affiliation: Department of Orthopedic Spinal Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. Dr.Hadi74@yahoo.com.
authors.forename: Abdollah
authors.initials: A
authors.lastname: Hadi
authors.affiliation: Department of Orthopedic, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mehran
authors.initials: M
authors.lastname: Feizi
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012544:Scheuermann Disease / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Kyphotic deformity; Scheuermann’s disease; Surgical correction outcome