TY - JOUR
T1 - Trends in Treatment of Scheuermann Kyphosis
T2 - A Study of 1,070 Cases From 2003 to 2012
AU - Horn, Samantha R.
AU - Poorman, Gregory W.
AU - Tishelman, Jared C.
AU - Bortz, Cole A.
AU - Segreto, Frank A.
AU - Moon, John Y.
AU - Zhou, Peter L.
AU - Vaynrub, Max
AU - Vasquez-Montes, Dennis
AU - Beaubrun, Bryan M.
AU - Diebo, Bassel G.
AU - Vira, Shaleen
AU - Raad, Micheal
AU - Sciubba, Daniel M.
AU - Lafage, Virginie
AU - Schwab, Frank J.
AU - Errico, Thomas J.
AU - Passias, Peter G.
N1 - Funding Information:
Author disclosures: SRH (none), GWP (none), JCT (none), CAB (none), FAS (none), JYM (none), PLZ (none), MV (none), DVM (none), BMB (none), BGD (none), SV (none), MR (none), DMS (none), VL (personal fees from DePuy Synthes, NuVasive, K2M, and Medtronic; other from Nemaris, outside the submitted work), FJS (grants from DePuy Synthes and SRS; personal fees from Zimmer Biomet, NuVasive, K2M, MSD, and Medicrea; other from Nemaris INC, outside the submitted work), TJE (none), PGP (personal fees from Medicrea and SpineWave; nonfinancial support from Zimmer-Biomet and Allosource; grants from CSRS, outside the submitted work).
Publisher Copyright:
© 2018 Scoliosis Research Society
PY - 2019/1
Y1 - 2019/1
N2 - Study Design: Retrospective review of KID Inpatient Database (KID) from 2003, 2006, 2009, and 2012. Objectives: The aim of this study was to evaluate the impact of advances in spinal surgery on patient outcomes in the treatment of Scheuermann kyphosis (SK). Summary of Background Data: SK is one of the most common causes of back pain in adolescents. Trends in diagnoses and surgical treatment and approach to SK have not been well described. Methods: SK patients aged 0–20 years in KID were identified by ICD-9 code 732.0. KID-supplied year- and hospital-trend weights were used to establish prevalence. Patient demographics, surgical details, and outcomes were analyzed with analysis of variance. Results: A total of 1,070 SK patients were identified (33.2% female), with increasing incidence of SK diagnosed from 2003 to 2012 (3.6–7.5 per 100,000, p <.001). The average age of operative patients was 16.1±2.0 years and did not change (16.27–16.06 years, p =.905). The surgical rate has not changed over time (72.8%–72.8%, p =.909). Overall, 96.3% of operative patients underwent fusion, with 82.2% of cases spanning ≥4 levels; in addition, 8.6% underwent an anterior-only surgery, 74.6% posterior-only, and 13.6% combined approach. From 2003 to 2012, rates of posterior-only surgeries increased (62.4%–84.4%, p <.001) whereas the rate of combined-approach surgeries decreased (37.6%–8.8%, p <.001). Overall complication rates for SK surgeries have decreased (2003: 20.9%; 2012: 11.9%, p =.029). Concurrently, the rate of ≥4-level fusions has increased (43.5%–89.6%, p <.001), as well as the use of Smith-Peterson (7.8%–23.6%, p <.001) and three-column osteotomies (0.0%–2.7%, p =.011). In subanalysis comparing posterior to combined approaches, complication rates were significantly different (posterior: 9.88%, combined: 19.46%, p =.005). Patients undergoing a combined approach have a longer length of stay (LOS) than patients undergoing a posterior-only approach (7.8 vs. 5.6 days, p <.001). Conclusions: Despite unchanged demographics and operative rates in SK, there has been a shift from combined to isolated posterior approaches, with a concurrent increase in levels treated. A combined approach was associated with increased complication rates, LOS, and total charges compared to isolated approaches. Awareness of these inherent differences is important for surgical decision making and patient education. Levels of Evidence: Level III.
AB - Study Design: Retrospective review of KID Inpatient Database (KID) from 2003, 2006, 2009, and 2012. Objectives: The aim of this study was to evaluate the impact of advances in spinal surgery on patient outcomes in the treatment of Scheuermann kyphosis (SK). Summary of Background Data: SK is one of the most common causes of back pain in adolescents. Trends in diagnoses and surgical treatment and approach to SK have not been well described. Methods: SK patients aged 0–20 years in KID were identified by ICD-9 code 732.0. KID-supplied year- and hospital-trend weights were used to establish prevalence. Patient demographics, surgical details, and outcomes were analyzed with analysis of variance. Results: A total of 1,070 SK patients were identified (33.2% female), with increasing incidence of SK diagnosed from 2003 to 2012 (3.6–7.5 per 100,000, p <.001). The average age of operative patients was 16.1±2.0 years and did not change (16.27–16.06 years, p =.905). The surgical rate has not changed over time (72.8%–72.8%, p =.909). Overall, 96.3% of operative patients underwent fusion, with 82.2% of cases spanning ≥4 levels; in addition, 8.6% underwent an anterior-only surgery, 74.6% posterior-only, and 13.6% combined approach. From 2003 to 2012, rates of posterior-only surgeries increased (62.4%–84.4%, p <.001) whereas the rate of combined-approach surgeries decreased (37.6%–8.8%, p <.001). Overall complication rates for SK surgeries have decreased (2003: 20.9%; 2012: 11.9%, p =.029). Concurrently, the rate of ≥4-level fusions has increased (43.5%–89.6%, p <.001), as well as the use of Smith-Peterson (7.8%–23.6%, p <.001) and three-column osteotomies (0.0%–2.7%, p =.011). In subanalysis comparing posterior to combined approaches, complication rates were significantly different (posterior: 9.88%, combined: 19.46%, p =.005). Patients undergoing a combined approach have a longer length of stay (LOS) than patients undergoing a posterior-only approach (7.8 vs. 5.6 days, p <.001). Conclusions: Despite unchanged demographics and operative rates in SK, there has been a shift from combined to isolated posterior approaches, with a concurrent increase in levels treated. A combined approach was associated with increased complication rates, LOS, and total charges compared to isolated approaches. Awareness of these inherent differences is important for surgical decision making and patient education. Levels of Evidence: Level III.
KW - Complications
KW - Posterior fusion
KW - Scheuermann kyphosis
KW - Surgical approach
KW - Surgical trends
KW - Trends
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U2 - 10.1016/j.jspd.2018.06.004
DO - 10.1016/j.jspd.2018.06.004
M3 - Article
C2 - 30587300
AN - SCOPUS:85050141471
SN - 2212-134X
VL - 7
SP - 100
EP - 106
JO - Spine deformity
JF - Spine deformity
IS - 1
ER -