Abstract
Objectives Scheuermann's kyphosis can cause severe back pain and cosmetic disorders to patients. Previous studies on surgical procedure selection for correction of Scheuermann's kyphosis have drawn controversial conclusions. Here, a meta-analysis was performed to figure out a better way between anterior-posterior (AP) combined procedures and posterior-only (PO) procedures. Methods We searched PubMed database and Ovid database, as well as Cochrane Library (between January 2009 and December 2020, around recent ten years), for studies reporting Scheuermann's kyphosis correction in an anterior way or a posterior way. Random effects meta-analysis regarding correction degrees and incidence of proximal junctional kyphosis (PJK) was performed. Results Finally, 13 unique studies including 586 patients (AP: 300; PO: 286) were identified and included for this meta-analysis. Overall, 6 AP cohorts and 10 PO cohorts were pooled regarding the correction degrees of kyphosis in the analysis, respectively. Pooled correction degrees in AP cohorts were 33.31 (95% CI: 27.48–39.15; I2 = 86%, P < 0.001) and in PO cohorts were 31.16 (95% CI: 26.97–35.35; I2 = 81.1%, P < 0.001). Comparison of correction between AP and PO cohorts did not indicate any significant difference. Likewise, postoperative PJK incidence showed no difference. Back pain can be caused by both AP and PO procedures, but which causes less pain remains to be conclusive. The PO approach showed less blood loss and shorter surgical duration as compared to the AP approach. Conclusions In summary, this meta-analysis shows similar treatment effects between AP and PO procedures in correcting Scheuermann's kyphosis, suggesting the advantage of PO procedures due to less blood loss and surgical duration. However, the postoperative complications PJK and distal junctional kyphosis (DJK) cannot be well concluded due to the limitation of existing data.
Highlights
Scheuermann’s kyphosis (SK) is a rigid developmental thoracic kyphosis, which can cause severe back pain and cosmetic disorders to patients [1, 2]
Conservative treatment measures are initially applied, surgical treatment is indicated for kyphosis that is over 70–75 degrees, with significant pain that has not responded to conservative management, and/or respiratory problems due to severe kyphosis, and neurological issues [3,4,5]. e surgical treatment consists of two different ways; one is the combined anterior-posterior approach (AP) and the other is a posterior-only way (PO), with various types of anchors [6, 7]
It was reported that a sufficient correction can be achieved by the PO approach, but the AP approach was more likely to get into a satisfying correction [8]
Summary
Scheuermann’s kyphosis (SK) is a rigid developmental thoracic kyphosis, which can cause severe back pain and cosmetic disorders to patients [1, 2]. Conservative treatment measures are initially applied, surgical treatment is indicated for kyphosis that is over 70–75 degrees, with significant pain that has not responded to conservative management, and/or respiratory problems due to severe kyphosis, and neurological issues [3,4,5]. It was reported that a sufficient correction can be achieved by the PO approach, but the AP approach was more likely to get into a satisfying correction [8]. A comparative study reported that the PO approach was more successful with a lower incidence of complications, as compared to the AP approach [9]. Koller et al [10] found that both approaches achieved similar degrees of correction with higher fusion level in the PO group, after comparing the AP with PO procedures in correcting kyphosis
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