title: National Trends in Spinal Fusion Surgery For Scheuermann Kyphosis.
abstract: METHODS
  Analysis of a national database.
  
  
  OBJECTIVE
  To analyze national trends in spinal fusion surgery for Scheuermann kyphosis (SK) and to compare surgical approaches used in treatment.
  
  
  BACKGROUND
  The preferred surgical approach for treating SK is not well established. Recent studies support the use of posterior spinal fusion (PSF) instead of anterior-posterior spinal fusion (APSF).
  
  
  METHODS
  Using the Nationwide Inpatient Sample database, we identified 2,796 patients (mean age, 24.9 years; 66% men) from 2000 to 2008 who had spinal fusion surgery for SK. We compared the two approaches with respect to patient demographics, institutional characteristics, in-hospital complications, and hospitalization lengths and costs. Significance was set at a value of p less than .05.
  
  
  RESULTS
  The number of spinal fusion surgeries performed in patients with SK increased significantly (p = .03). The proportion of patients undergoing surgery as adults also increased significantly (p < .05). The number of PSF surgeries performed in patients with SK increased 2.9-fold (34% to 78%) (p < .01); APSF use declined by 7% per year. There was no significant association among surgical approach and patient age, sex, hospital capacity, or teaching status. Compared with patients undergoing PSF, patients undergoing APSF had 2.1-fold more in-hospital complications (p < .01), 3.8-fold more pulmonary complications (p < .01), 2.7-fold more renal complications (p < .01), and significantly longer hospitalizations (mean, 8.5 days vs. 5.9 days, respectively; p < .01). There was no significant difference in mean total hospital charges: $117,921 for APSF and $119,322 for PSF.
  
  
  CONCLUSIONS
  There have been significant increases in the number of spinal fusion surgeries for SK, and in the proportion of patients with SK who are choosing surgery as adults. Surgical treatment has shifted predominantly toward an all-posterior approach. PSF is associated with lower complication rates (especially pulmonary complications) and shorter hospitalizations.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA. Electronic address: ehenze1@jhmi.edu.
authors.forename: Addisu
authors.initials: A
authors.lastname: Mesfin
keywords: Complications; Pediatric deformity; Posterior fusion; Scheuermann kyphosis; Spinal fusion