R. Poolman, H. Been, L. Ubags
December 2002, Volume 11, Issue 6, pp 561 - 569 Original Article Read Full Article 10.1007/s00586-002-0418-6
First Online: 01 December 2002
The aim of this prospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome, and to report complications and instrumentation failure after operative treatment of Scheuermann's disease using a combined anterior and posterior spondylodesis. The loss of sagittal plane correction after removal of the posterior instrumentation was analysed. The indication for surgery was a thoracic kyphosis greater than 60° in adolescents and adults with persistent back pain, which failed to respond to conservative treatment. Thoracic kyphosis and lumbar lordosis angles were measured by the Cobb method at preselected time points and at final follow-up. Sagittal plane alignment was measured as translation. The validated Scoliosis Research Society Instrument (SRSI) questionnaire was sent to all patients at follow-up. P-values were calculated using the Wilcoxon signed rank test (P<0.05 is significant). Between October 1987 and August 1999, 23 consecutive patients underwent operative treatment. The median follow-up was 75 months (range 25–126 months). Median preoperative thoracic kyphosis was 70° (range 62°–78°) and median preoperative lumbar lordosis was 68° (range 54°–84°). Immediate postoperative median thoracic kyphosis was 39° (range 28°–54°) (P<0.05) and immediate postoperative median lumbar lordosis was 49° (range 35°–63°) (P<0.05). These significant corrections were maintained at early follow-ups conducted 1 year and 2 years postoperatively. At final follow-up, the median thoracic kyphosis had significantly increased, to 55° (range 36°–65°) (P<0.05 relative to immediate postoperative value), and the median lumbar lordosis had increased to 57° (range 44°–70°) (P<0.05). The late deterioration of correction in the sagittal plane was mainly caused by removal of the posterior instrumentation, and occurred despite radiographs, bone scans and thorough intra-operative explorations demonstrating solid fusions. The median SRSI score was 83 points (range 55–106). There was no significant correlation between the radiographic outcome and the SRSI score (P>0.05). Our series showed relatively fair outcome after operative treatment in Scheuermann's disease. Therefore, the indication for surgery in patients with Scheuermann's disease can be questioned.
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