title: Poor Radiological and Good Functional Long-term Outcome of Surgically Treated Scheuermann Patients.
abstract: METHODS
  Cohort study.
  
  
  OBJECTIVE
  To analyze long-term clinical and radiological outcomes of surgically treated Scheuermann patients.
  
  
  BACKGROUND
  Long-term clinical and radiological outcomes of surgery for Scheuermann kyphosis are unknown. A single-center cohort of 33 consecutive, surgically treated (between 1991 and 1998) Scheuermann patients was studied.
  
  
  METHODS
  Clinical and radiological data of 29 surgically treated Scheuermann patients were collected (posterior approach n = 13; combined anterior-posterior procedure n = 16), after a mean follow-up of 18 years. Oswestry Disability Index (ODI) scores were measured preoperatively (PRE) and twice postoperatively: 2 to 8 years postoperative (FU 1) and 14 to 21 years postoperative (FU 2). Visual Analog Score pain, Short Form-36 (SF-36), and EQ-5d scores were recorded at FU 2 only. Radiographs were analyzed for correction, distal and proximal junctional kyphosis, and implant failures.
  
  
  RESULTS
  Mean preoperative kyphosis of the corrected levels was 76° (range 60°-105°) and decreased to a Cobb of 58°(range 30°-105°) at FU 2. Median Visual Analog Score was 2.5 points (range 0-8) and median ODI score was 12 (range 0-62) at FU 2. The ODI score at FU 1 was significantly better as compared to PRE (P < 0.001) and FU 2 (P < 0.001). Also, anterior-posterior treated group had a significantly better ODI score as compared to the posterior-only group (P = 0.023). EQ-5d scores on mobility, usual activities, and pain/discomfort were worse compared to an age-matched population control group; however, SF-36 outcome scores were comparable.Proximal junctional kyphosis was present in 53% of patients, distal junctional kyphosis did not occur, and implant failure/removal had occurred in 69% of patients. Radiological complications do not relate with the ODI, EQ-5d, and SF-36 and 72% of the patients were satisfied.
  
  
  CONCLUSIONS
  Radiological results of this cohort were disappointing but did not relate to clinical outcome scores. Even lumbar pain could not prevent a high patient satisfaction and quality of life. Patients treated with a combined anterior-posterior approach tended to perform better.
  
  
  METHODS
  3.
authors.affiliation: Department of orthopaedic surgery, Sint Maartenskliniek, Ubbergen, the Netherlands.|Department of orthopaedic surgery, Medisch Centrum Alkmaar, The Netherlands.
authors.forename: Harm C A
authors.initials: HCA
authors.lastname: Graat
authors.affiliation: Department of Research, Sint Maartenskliniek, Ubbergen, The Netherlands.
authors.forename: Janneke J P
authors.initials: JJP
authors.lastname: Schimmel
authors.affiliation: Department of orthopaedic surgery, Sint Maartenskliniek, Ubbergen, the Netherlands.
authors.forename: Roel J W
authors.initials: RJW
authors.lastname: Hoogendoorn
authors.affiliation: Department of orthopaedic surgery, Sint Maartenskliniek, Ubbergen, the Netherlands.
authors.forename: Lotte
authors.initials: L
authors.lastname: van Hessem
authors.affiliation: Department of orthopaedic surgery, University Medical Center Nijmegen, Nijmegen, The Netherlands.
authors.forename: Allard
authors.initials: A
authors.lastname: Hosman
authors.affiliation: Department of orthopaedic surgery, Sint Maartenskliniek, Ubbergen, the Netherlands.|Department of orthopaedic surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Marinus
authors.initials: M
authors.lastname: de Kleuver
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012544:Scheuermann Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery; D016896:Treatment Outcome