Scheuermann’s Kyphosis Surgery Complication

Abstract

Scheuermann’s kyphosis (SK) presents as increased thoracic kyphosis or loss of lumbar lordosis with pathognomonic irregularities of the vertebral end plates. The majority of patients can be managed nonoperatively with bracing, short-term courses of NSAIDs, and physical therapy to address muscular discomfort. Surgical intervention should be considered for symptomatic patients with kyphosis exceeding 75°; however, smaller magnitude curves are also considered surgical if located in the thoracolumbar spine, if they are progressive, or if associated with significant pain or neurologic symptoms. A posterior approach with multilevel posterior column osteotomies at the apex of the deformity, segmental instrumentation, and fusion is the workhorse procedure. Junctional kyphosis is a complication that can often be avoided through careful selection of the upper (UIV) and lower instrumented vertebrae (LIV). In SK, the UIV should be the end vertebra; however, this is often difficult to visualize on lateral films, and therefore a line of best-fit technique may be used to aid selection. LIV is identified as the sagittal stable vertebra. Surgical correction of thoracic kyphosis and lumbar lordosis to values that are harmonious with the pelvic incidence (PI) is also important in preventing junctional kyphosis. In general terms, patients with high PI should be left with a larger thoracic kyphosis, while patients with relatively low PI should have a straighter sagittal profile. Asymptomatic, nonprogressive proximal junctional kyphosis (PJK) may be managed expectantly. The presence of progressive kyphosis, instability, or neurologic symptoms would mandate revision surgery with extension of the fusion proximally to a neutral or lordotic level.