medigraphic.com
ISSN 2992-7749 (Electronic)
ISSN 2992-7897 (Print)
Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2026, Number 1

<< Back Next >>

Cir Columna 2026; 4 (1)

Description of the characteristics of patients with Scheuermann's disease undergoing posterior instrumented arthrodesis who develop proximal or distal junctional kyphosis

Galo TSF, Ramírez GDG, Canales NJA, Hurtado PA

Language: Spanish
References: 18
Page: 6-11
PDF size: 249.80 Kb.


ABSTRACT

Introduction: Scheuermann's disease is a structural hyperkyphosis that primarily affects adolescents. Surgical treatment with posterior instrumented arthrodesis (PIA) achieves effective angular correction; however, it may be associated with complications such as proximal junctional kyphosis (PJK) and distal junctional kyphosis (DJK), which can compromise long-term clinical and radiographic outcomes. Objective: to describe the characteristics of patients with Scheuermann's disease who underwent posterior instrumented arthrodesis and subsequently developed PJK and/or DJK. Material and methods: this was a retrospective, observational, and descriptive study of 25 patients aged 12 to 18 years with Scheuermann's disease who underwent surgery between 2020 and 2023 at Shriners Hospital for Children Mexico. Radiographic variables such as thoracic kyphosis, lumbar lordosis, pelvic incidence, sagittal translation, instrumented levels, and PJK and DJK angles were analyzed in the immediate postoperative period and at one-year follow-up. Results: the mean preoperative kyphosis was 78.7°, corrected to 61.8° postoperatively. PJK was present in 64% of patients at hospital discharge and in 68% at one year. DJK was evident in 56% immediately postoperatively and in 68% at one year. Among patients with DJK, 64% were instrumented to the last lordotic vertebra. Most cases of PJK and DJK occurred in patients with neutral sagittal balance. Conclusions: complications such as PJK and DJK are frequent after surgery. The choice of instrumentation levels and sagittal balance may influence their development.


REFERENCES

  1. Lowe TG. Scheuermann's kyphosis. Neurosurg Clin N Am. 2007; 18: 305-315.

  2. Ristolainen L, Kettunen JA, Kujala UM, Heinonen A, Schlenzka D. Progression of thoracic Scheuermann's kyphosis after skeletal maturity. Spine. 2012; 37: E1278-E1283.

  3. Sorensen KH. Scheuermann's juvenile kyphosis: clinical appearances, radiography, aetiology, and prognosis. Copenhagen: Munksgaard; 1964.

  4. Wenger DR, Frick SL. Scheuermann kyphosis. Spine. 1999; 24: 2630-2639.

  5. Scheuermann H. Juvenile kyphosis. Acta Orthop Scand. 1934; 5: 1-46.

  6. McMaster MJ, O'Brien MF. Scheuermann kyphosis: long-term results of surgical treatment. Spine. 1991; 16: 691-695.

  7. Lowe TG, Line BG. Evidence based medicine: analysis of Scheuermann kyphosis. Spine. 2007; 32: S115-S119.

  8. Tsirikos AI, Jain AK. Scheuermann's kyphosis: current controversies. J Bone Joint Surg Br. 2011; 93: 857-864.

  9. Smith JS, Kebaish KM. Management of complications following deformity correction surgery in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2011; 36: 2229-2236.

  10. Zhan L, Lee C, Chang Y, et al. Complications of spinal deformity surgery in adults: a retrospective analysis. J Neurosurg Spine. 2012; 17: 315-324.

  11. Yoshida G, Nakajima H, Yamato Y, et al. Proximal junctional kyphosis following thoracic spinal fusion for scoliosis. Eur Spine J. 2014; 23: 1-6.

  12. Lee C, Kim Y, Chang H, et al. Proximal junctional kyphosis after corrective surgery for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2012; 37: 630-635.

  13. Kebaish KM, Fisher RP. Treatment of adult scoliosis. Neurosurg Clin N Am. 2008; 19: 475-482.

  14. Lee C, Lee Y, Moon S, et al. The impact of kyphosis and lordosis alignment on the development of proximal junctional kyphosis after adult spinal deformity surgery. Spine (Phila Pa 1976). 2017; 42: E307-E314.

  15. Kwon B, Lenke LG. Proximal junctional kyphosis following spinal deformity surgery. Neurosurg Focus. 2010; 29: E2.

  16. Cho KJ, Kim JH, Kim KJ, et al. Risk factors for proximal junctional kyphosis following adult spinal deformity surgery. Spine J. 2015; 15: 844-853.

  17. Shigematsu H, Fujita N, Takahashi H, et al. Proximal junctional kyphosis following correction of adolescent idiopathic scoliosis: a comparison of two types of surgery. Eur Spine J. 2017; 26: 2975-2980.

  18. Fujita N, Yagi M, Tsuji T, et al. Incidence and risk factors for distal junctional kyphosis following posterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2014; 39: E1414-E141.



EVIDENCE LEVEL

IV, serie de casos retrospectiva.




2020     |     www.medigraphic.com