SELECTION OF OPTIMAL LEVEL OF DISTAL FIXATION FOR CORRECTION OF SCHEUERMANN’S HYPERKYPHOSIS
https://doi.org/10.14531/ss2012.2.24-29
Abstract
Objective. To analyze the efficacy of the method for selecting the distal level of fusion in treatment of thoracic hyperkyphosis in Scheuermann’s disease.
Material and Methods. Treatment results in 36 patients operated on in the Department of Children and Adolescent Spine Pathology during 2007-2010 were analyzed. Patients were divided into two groups: in Group 1 (n = 29) a lower instrumented vertebra corresponded to the sagittal stable one, and in Group 2 (n = 7) this vertebra located proximally.
Results. The mean preoperative magnitude of kyphosis was 79.3° ± 11.6°, postoperative - 40.6° ± 11.9° (correction 49.9 %), and loss of correction was 4.9° ± 7.0°. Sagittal balance changed from -0.3 ± 3.2 cm before surgery to -1.7 ± 2.1 cm. Distal junctional kyphosis developed in 1 case (4 %) in Group 1, and in 5 cases (71 %) in Group 2.
Conclusion. Distal level of instrumentation ending at the first lordotic vertebra is not justified and causes violation of sagittal balance and development of distal junctional kyphosis. Including sagittal stable vertebra in fusion prevents the development of distal junctional kyphosis. Hir. Pozvonoc. 2012;(2):24-29.
About the Authors
Mikhail Vitalyevich Mikhailovsky
Novosibirsk Research Institute of Traumatology and Orthopaedics
Russian Federation
Russian Federation
Artyom Nikolayevich Sorokin
Novosibirsk Research Institute of Traumatology and Orthopaedics
Russian Federation
Russian Federation
Vyacheslav Viktorovich Novikov
Novosibirsk Research Institute of Traumatology and Orthopaedics
Russian Federation
Russian Federation
Aleksandr Sergeyevich Vasyura
Novosibirsk Research Institute of Traumatology and Orthopaedics
Russian Federation
Russian Federation
References
1. Ветрилэ С.Т., Кулешов А.А., Швец В.В. и др. Оперативное лечение тяжелых деформаций позвоночника // Вестник РАМН. 2008. № 8. С. 34-40.
2. Михайловский М.В., Новиков В.В., Васюра А.С. и др. Коррекция кифозов на почве болезни Шейерманна // Хирургия позвоночника. 2005. № 2. С. 50-55.
3. Михайловский М.В., Сорокин А.Н., Новиков В.В. и др. Результаты хирургического лечения кифозов с применением сегментарного инструментария при болезни Шейерманна // Хирургия позвоночника. 2011. № 4. С. 27-34.
4. Михайловский М.В., Фомичев Н.Г. Хирургия деформаций позвоночника. Новосибирск, 2002.
5. Райе Р.Э. Коррекция деформаций позвоночника с помощью инструментария Cotrel - Dubousset // Проблемы хирургии позвоночника и спинного мозга: Тез. докл. Всерос. науч.-практ. конф. Новосибирск, 1996. С. 89-90.
6. Ascani E, La Rosa G. Schueurmann’s kyphosis. In: Weinstein SL (ed.). The Pediatric Spine: Principles and Practice. N. Y., 1994: 557-641.
7. Bradford DS, Ahmed KB, Moe JH, et al. The surgical management of patients with Scheuermann’s disease: a review of twenty-four cases managed by combined anterior and posterior spine fusion. J Bone Joint Surg Am. 1980; 62: 705-712.
8. Cho KJ, Lenke LG, Bridwell KH, et al. Selection of the optimal distal fusion level in posterior instrumentation and fusion for thoracic hyperkyphosis: the sagittal stable vertebra concept. Spine. 2009; 34: 765-770.
9. Cobb JR. Outline for the study of scoliosis. AAOS Instr Course Lect. 1948; 5: 621-675.
10. De Jonge T, Iles T, Bellyei A. Surgical correction of Scheuermann’s kyphosis. Int Orthop. 2001; 25: 70-73.
11. Herndon WA, Emans JB, Micheli LJ, et al. Combined anterior and posterior fusion for Scheuermann’s kyphosis. Spine. 1981; 6: 125-130.
12. Hosman AJ, Langeloo DD, de Kleuver M, et al. Analysis of the sagittal plane after surgical management for Scheuermann’s disease: a view on overcorrection and use of an anterior release. Spine. 2002; 27: 167-175.
13. Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size: a prospective controlled clinical study. Spine. 1994; 19: 1611-1618.
14. King HA, Moe JH, Bradford DS, et al. The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am. 1983; 65: 1302-1313.
15. Lowe TG, Kasten MD. An analysis of sagittal curves and balance after Cotrel -Dubousset Instrumentation for kyphosis secondary to Scheuermann’s disease. A review of 32 patients. Spine. 1994; 19: 1680-1685.
16. Otsuka NY, Hall JE, Mah JY. Posterior fusion for Scheuermann’s kyphosis. Clin Orthop Relat Res. 1990;(251): 134-139.
17. Papagelopoulos PJ, Klassen RA, Peterson HA, et al. Surgical treatment of Scheuermann’s disease with segmental compression instrumentation. Clin Ortop Relat Res. 2001;(386): 139-149.
18. Sturm PF, Dobson JC, Armstrong GW. The surgical management of Scheuermann’s disease. Spine. 1993; 18: 685-691.
19. Taylor TC, Wenger DR, Stephen J, et al. Surgical management of thoracic kyphosis in adolescents. J Bone Joint Surg Am. 1979; 61: 496-503.
20. Wenger D, Frick S. Scheuermann kyphosis. Spine. 1999; 24: 2630-2639.
Review
For citations:
Mikhailovsky M.V., Sorokin A.N., Novikov V.V., Vasyura A.S. SELECTION OF OPTIMAL LEVEL OF DISTAL FIXATION FOR CORRECTION OF SCHEUERMANN’S HYPERKYPHOSIS. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2012;(2):24-29. https://doi.org/10.14531/ss2012.2.24-29
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