Posterior Surgery in Scheuermann's Kyphosis: A Retrospective Review of 210 Cases

Abstract

Background: Scheuermann’s kyphosis (SK), also known as juvenile kyphosis, is one of the most common causes of spinal deformity in adolescents. The objective of this study was to review the outcomes of posterior-only surgical correction for SK over 25 years. Methods: We retrospectively reviewed patients diagnosed with SK who underwent posterior spinal surgery. Health-related quality of life (HRQoL) was assessed using the Oswestry Disability Index (ODI) and the Scoliosis Research Society-30 questionnaire (SRS-30). Additionally, radiographic parameters were evaluated preoperatively and at follow-up. Results: A total of 210 patients with SK underwent posterior-only surgical correction. The mean age at surgery was 17.5 years (range: 12-38 years), with a mean follow-up of 17.5 years. Significant improvements were observed in sagittal Cobb angle (85.9° to 43.2°, P < 0.001), coronal Cobb angle (32.5° to 11.5°, P < 0.001), L1-S1 lordosis (P = 0.001), and sagittal balance (P = 0.043). Clinical outcomes assessed at the 6-month postoperative follow-up also improved significantly, with the ODI decreasing from 23.2 to 5.8 (P = 0.003) and the SRS-30 score increasing from 64.0 to 133.5 (P < 0.001). The mean pelvic incidence (PI) was 46°, with no significant correlation between PI and either the preoperative sagittal Cobb angle (P = 0.46) or kyphosis correction (P = 0.70). However, based on our clinical observations, postoperative kyphosis correction approximating the patient's PI appeared to be associated with more favorable outcomes. This observation should be considered exploratory and requires prospective validation. The overall complication rate was 4%, and the mean loss of correction at the final follow-up was 1.6°. Conclusion: A posterior-only approach is an effective and safe treatment for SK; however, whether correction approximating PI can optimize individualized outcomes remains a hypothesis requiring prospective evaluation.