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Thread: Orthopaedic management of Scheuermann's

  1. #16
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    Study Design. A historic cohort study was conducted to investigate surgical correction and sagittal alignment in 33 patients with thoracic Scheuermann's disease.

    Objective. To evaluate kyphosis correction, correction loss, sagittal balance, and the effect of an anterior release.

    Summary of Background Data. Currently, both posterior and anteroposterior techniques seem to produce impressive corrections for Scheuermann's disease. However, few reports have been made on sagittal malalignment after surgery.

    Methods. A cohort of 33 patients who had undergone surgery for their Scheuermann's kyphosis were reviewed: Group A: posterior technique (n = 16), Group B: anteroposterior technique (n = 17). Pre- and postoperative curve morphometry (Cobb, Ferguson, Voutsinas), balance (C7 plumb line), and Oswestry score were compared.

    Results. The mean follow-up period was 4.5 +/- 2 years (range, 2-8.2 years). The mean preoperative kyphosis (Cobb) was 78.7[degrees] +/- 8.9[degrees], and the mean postoperative kyphosis was 51.7[degrees] +/- 10.3[degrees]. At follow-up evaluation, the correction loss was 1,4[degrees] +/- 3.9[degrees]. There was no difference in curve morphometry, correction, sagittal balance, average age, and follow-up period between Groups A and B. One junctional kyphosis, in Group B, was noted. After surgery, all the patients were satisfied, and the Oswestry score showed significant improvement. No neurologic complications were observed.

    Conclusions. Good follow-up results included a 100% follow-up rate, adequate corrections, little correction loss, lower Oswestry scores, and a high satisfaction rate in both groups. The anteroposterior treatment did not influence the curve morphometry more than posterior fusion only. In reducing postoperative sagittal malalignment, the authors believe that surgical management should aim at a correction within the high normal kyphosis range of 40[degrees] to 50[degrees], consequently providing good results and, particularly in flexible adolescents and young adults, minimizing the necessity for an anterior release.
    Latitude: 54 57' 34" N Longitude: 1 25' 16" W


    Mark's a groovin an a movin

  2. #17
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    Abstract. The aim of this prospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome, and to report complications and instrumentation failure after operative treatment of Scheuermann&#39;s disease using a combined anterior and posterior spondylodesis. The loss of sagittal plane correction after removal of the posterior instrumentation was analysed. The indication for surgery was a thoracic kyphosis greater than 60 in adolescents and adults with persistent back pain, which failed to respond to conservative treatment. Thoracic kyphosis and lumbar lordosis angles were measured by the Cobb method at preselected time points and at final follow-up. Sagittal plane alignment was measured as translation. The validated Scoliosis Research Society Instrument (SRSI) questionnaire was sent to all patients at follow-up. P-values were calculated using the Wilcoxon signed rank test (P<0.05 is significant). Between October 1987 and August 1999, 23 consecutive patients underwent operative treatment. The median follow-up was 75 months (range 25-126 months). Median preoperative thoracic kyphosis was 70 (range 62-78) and median preoperative lumbar lordosis was 68 (range 54-84). Immediate postoperative median thoracic kyphosis was 39 (range 28-54) (P<0.05) and immediate postoperative median lumbar lordosis was 49 (range 35-63) (P<0.05). These significant corrections were maintained at early follow-ups conducted 1 year and 2 years postoperatively. At final follow-up, the median thoracic kyphosis had significantly increased, to 55 (range 36-65) (P<0.05 relative to immediate postoperative value), and the median lumbar lordosis had increased to 57 (range 44-70) (P<0.05). The late deterioration of correction in the sagittal plane was mainly caused by removal of the posterior instrumentation, and occurred despite radiographs, bone scans and thorough intra-operative explorations demonstrating solid fusions. The median SRSI score was 83 points (range 55-106). There was no significant correlation between the radiographic outcome and the SRSI score (P>0.05). Our series showed relatively fair outcome after operative treatment in Scheuermann&#39;s disease. Therefore, the indication for surgery in patients with Scheuermann&#39;s disease can be questioned.
    Latitude: 54 57' 34" N Longitude: 1 25' 16" W


    Mark's a groovin an a movin

  3. #18
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    http://www.cpsp.edu.pk/jcpsp/ARCHIEV.../Article17.pdf

    NEUROLOGIC COMPRESSION BY THORACIC DISC IN A
    CASE OF SCHEUERMANN KYPHOSIS - AN INFREQUENT
    COMBINATION
    Latitude: 54 57' 34" N Longitude: 1 25' 16" W


    Mark's a groovin an a movin

  4. #19
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    Thanks Mark&#33; That&#39;s what I&#39;m having problems with at the moment and it&#39;s flippin killing me&#33;
    Born 1981 with Spina Bifida Myelomeningocele. Surgery to close lesion at birth. Anterior fusion T11-L5 aged 12. Laminectomy June 06. Posterior fusion with instrumenation T8-T11. Degenerative Disc C4/C5

    Under the care of Jeremy Fairbank.

  5. #20
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    Hi Ali

    I&#39;m glad you found it useful sometimes you put things up and you wonder if its of any use thanks for the feed back
    Hope the pain is a little easier

    Take care

    Mark
    Latitude: 54 57' 34" N Longitude: 1 25' 16" W


    Mark's a groovin an a movin

  6. #21
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    All the Scheuermann&#39;s links gathered together for easy reference
    Latitude: 54 57' 34" N Longitude: 1 25' 16" W


    Mark's a groovin an a movin

  7. #22
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    Please feel free to add any articles or useful websites

    Thanks

    Mark
    Latitude: 54 57' 34" N Longitude: 1 25' 16" W


    Mark's a groovin an a movin

  8. #23
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    http://www.srs.org/professionals/resources...ns_kyphosis.pdf

    Another interesting article. However the use of the term hunchback in a proffesional paper does make me wince
    Latitude: 54 57' 34" N Longitude: 1 25' 16" W


    Mark's a groovin an a movin

  9. #24
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    Latitude: 54 57' 34" N Longitude: 1 25' 16" W


    Mark's a groovin an a movin

  10. #25
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    Since there hasn&#39;t been much activity in the kyphosis forum, I thought I&#39;d add some links I&#39;ve come across while researching treatments. Most of these revolve around spinal fusion.

    Spinal Fusion - General Information
    http://www.spine.org/articles/spinalfusion.cfm
    http://orthoinfo.aaos.org/fact/thr_r...?Thread_ID=156
    http://orthopedics.about.com/od/spin...y/a/fusion.htm
    http://adam.about.com/encyclopedia/Spinal-fusion.htm

    Spinal Fusion - Lumber Fusion
    http://www.spine-health.com/topics/surg/ov...bar/lumb05.html

    I&#39;ll post some more later.

  11. #26
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  12. #27
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    Thumbs down Re: Orthopaedic management of Scheuermann's

    I DON'T LIKE THE CONSTANT REFERENCE TO DISEASE. SCHEUERMANN'S ISN'T SOMETHING YOU CATCH DOWN AT THE SWIMMING POOL
    ya calling it a disease it a little extreme

  13. #28
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    Default Re: Orthopaedic management of Scheuermann's

    when i was at ft. knox all my buddies jokingly called me the hunchback of ft. knox. Not going to lie it kinda pissed me off haha. I got discharged for it but again, nobody was able to tell me exactly what I had. There arent very many things that piss me off either.

  14. #29
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    Default Re: Orthopaedic management of Scheuermann's

    I am new here and learning quite a bit very fast. So far from reading a ton of information and talking with many people who have had spinal fusion, there hasn't seemed to be to much of a downside. (well besides recovery) Am I correct on this?

    My son is 10 and will be 11 in June. He has Kyphosis and scoliosis. His spinal curving is progressing faster than anyone expected and surgery has been brought to the table or bracing him for 6 years and then still possibly needing surgery.

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