SELECTION OF 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 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.