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How to determine the optimal proximal fusion level for Scheuermann kyphosis

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Abstract

Objective

To determine optimal proximal fusion levels for instrumented spinal fusion for Scheuermann kyphosis.

Methods

We reviewed 86 patients (33 women) who underwent corrective instrumented spinal fusion for Scheuermann kyphosis. All patients had long-cassette upright lateral radiographs taken preoperatively, postoperatively, and at 2 years and the last follow-up. Demographic, radiographic, and surgical parameters were compared between patients with and without PJK.

Results

PJK occurred in 28 patients (32%). The mean maximum Cobb angle was 85.8° ± 11.7° preoperatively, 54.8° ± 14.2° postoperatively, and 59.7° ± 16.8° at the last follow-up. Age and sex did not differ between the PJK and non-PJK groups (P > 0.05). The preoperative curve characteristics, fusion levels, and corrective ratio were similar in both groups (P > 0.05). The maximal Cobb angle at 2 years and the last follow-up significantly differed between the 2 groups (P < 0.05). The proportion of patients with the uppermost instrumented vertebra (UIV) at or above the proximal end vertebra (PEV) was similar in both groups (P > 0.05). The proportion of patients with UIV at or above T2 was significantly greater in the non-PJK group (P < 0.05). PJK was significantly associated with a C7 plumb line (C7PL)-sacrum distance ≥ 50 mm (P < 0.05).

Conclusion

PJK is the main cause of postoperative correction loss. Proper fusion-level selection can reduce PJK occurrence. We recommend having the UIV at T2 or above, especially when the C7PL-sacrum distance ≥ 50 mm.

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Acknowledgements

We thank Medjaden Inc. for its assistance in the preparation of this manuscript.

Funding

This work was supported by Beijing Natural Science Foundation, 7232336.

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Authors and Affiliations

  1. Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China

    Ning Yuan

  2. Department of Orthopedic Surgery, Shenzhen Nanshan People Hospital, Shenzhen, Guangzhou Province, China

    Guangxun Hu

  3. Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA

    Keith H. Bridwell & Linda A. Koester

  4. Department of Orthopedic Surgery, Columbia University/New York-Presbyterian-Spine Hospital, New York, NY, USA

    Lawrence G. Lenke

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  1. Ning Yuan
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  2. Guangxun Hu
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  3. Keith H. Bridwell
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  4. Linda A. Koester
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  5. Lawrence G. Lenke
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Correspondence to Ning Yuan.

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Yuan, N., Hu, G., Bridwell, K.H. et al. How to determine the optimal proximal fusion level for Scheuermann kyphosis. Eur Spine J 33, 1021–1027 (2024). https://doi.org/10.1007/s00586-023-08029-0

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  • DOI: https://doi.org/10.1007/s00586-023-08029-0

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