An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann's disease. A review of 32 patients
Lowe, T.G.; Kasten, M.D.
Spine 19(15): 1680-1685
1994
ISSN/ISBN: 0362-2436 PMID: 7973960 Document Number: 435648
Study Design. This study compared preoperative and postoperative sagittal curves and spinal balance in patients undergoing spinal fusion with Cotrel-Dubousset instrumentation for severe kyphosis secondary to Scheuermann's disease. Also determined was patients satisfaction regarding relief of pain and correction of the deformity. Thirty two patients with kyphosis gt 75 degree underwent spinal fusion with Cotrel-Dubousset instrumentation. Objectives. To evaluate the initial and long-term correction of the primary kyphosis and changes in lumbar lordosis and sagittal balance, and to determine the incidence and etiology of junctional sagittal deformities. Summary of Background Data. The average preoperative kyphosis was 85% (range, 75 degree to 105 degree ) with an average correction at final follow-up of 43 degree (range, 26 degree to 65 degree ). Preoperative lumbar lordosis averaged 75 degree (range, 58 degree to 100 degree ) and at final follow-up averaged 55 degree (range, 23 degree to 74 degree ). Most of the patients demonstrated negative sagittal balance and became slightly more negatively balanced postoperatively. Results. Maintenance of correction postoperatively was excellent, with only a 4 degree average loss of correction. There was spontaneous reduction in lumbar lordosis of varying degrees. Proximal junctional kyphosis was associated with over correction ( gt 50%) of the kyphotic deformity or a fusion starting short of the proximal vertebra in the measured kyphosis. Distal junctional kyphosis developed in patients whose fusion ended short of the first lordotic segment. Conclusions. This procedure appeared to yield good results when proper levels of fusion were selected and correction gt 50% was not attempted.