Eyal Behrbalk, Ofir Uri, Ruth M. Parks, Michael Paul Grevitt, Marcus Rickert, Bronek Maximilian Boszczyk


September 2014, Volume 23, Issue 10, pp 2203 - 2210 Original Article Read Full Article 10.1007/s00586-014-3472-y

First Online: 08 August 2014

Introduction

Posterior-only approach using pedicle screws’ fixation has emerged as the preferred surgical technique for Scheuermann kyphosis (SK) correction. Insertion of multiple pedicle screws while increasing stability increases also the risk of complications related to screw malpositioning and surgical cost. The optimal screw density required in surgical correction of SK remains unclear. This study compares the safety and efficacy of low screw density (LSD) versus high screw density (HSD) technique used in posterior-only correction of SK.

Methods

Twenty-one patients underwent surgical correction of SK between 2007 and 2011 and were reviewed after a mean of 29 months. HSD technique (i.e., 100 % of available pedicles, averaged 25.2 ± 4 screws) was used in 10 cases and LSD technique (i.e., 54–69 % of available pedicles in a pre-determined pattern, averaged 16.8 ± 1.3 screws; p 

Results

Preoperative thoracic kyphosis, lumbar lordosis and sagittal balance were similar for both groups. The average postoperative kyphosis correction was similar in both HSD and LSD groups (29° ± 9° vs. 34° ± 6°, respectively; p = 0.14). Complication occurred in four patients (19 %) in the HSD group and in two patients (9 %) in the LSD group (p = 0.56). Three patients required re-operation. Compared to HSD using LSD saves 4,200£ per patient in hardware and 88,200£ for the entire cohort.

Conclusion

LSD technique is as safe and effective as HSD technique in posterior-only correction of SK. Implant-related cost could be reduced by 32 %.


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