Selection Of The Optimal Level Of Distal Fixation For Correction Of Scheuermann’s Hyperkyphosis

OBJECTIVE: To analyze the efficacy of the method for selecting the distal level of fusion in treatment of thoracic hyperkyphosis in patients with Scheuermann's disease. BACKGROUND: The fusion area needs to include all the kyphotic deformity in Scheuermann patients; however, precise levels of the distal fixation have not been determined yet. STUDY DESIGN: Retrospective cohort review. MATERIALS AND METHODS: Thirty-six patients were operated in the Department of Children and Adolescent Spine Pathology between 2007 and 2010. These patients were divided into two groups: in group I (n = 29) a lower instrumented vertebra corresponded to the sagittal stable one and in group II (n = 7) - this vertebra located proximally. RESULTS: The mean preoperative kyphosis was 79.3° ± 11.6°, the postoperative - 40.6° ± 11.9° (correction of 49.9%), 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 after surgery. Distal junctional kyphosis developed in 1 case (4%) in Group I, and in 5 cases (71%) in Group II. CONCLUSION: A 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. The inclusion of a sagittal stable vertebra in fusion prevents the development of this undesirable situation.