Comparison of anteroposterior to posterior-only correction of Scheuermann's kyphosis: A matched-pair radiographic analysis of 92 patients

Study Design Retrospective radiographic benchmark study. Objective To evaluate the amount of instrumented correction obtained from a combined anterior/posterior (A/P) versus posterior-only (post-only) approach for Scheuermann's kyphosis. Summary of Background Data An A/P approach was thought to optimize correction; however, instrumentation advances using pedicle screws allow treatment through an all-posterior approach. Methods A total of 166 Scheuermann's kyphosis patients were treated between 2 centers: 90 by combined A/P approach at 1 center and 76 by post-only at the second center. From the 166 patients, a matched cohort of 92 (46 from each) was established according to preoperative sagittal (±10°) and hyperextension (HE) Cobb (±10°) measurements and matched for age and gender. Results In the matched-pair group, average preoperative sagittal Cobb angles were 75.9° for the A/P group versus 78.8° for the post-only group (p =.2). The HE Cobb angles were similar (52.4° vs. 51.1°; p =.6). They showed similar corrections (33.7° vs. 30.6°; p =.3) and postoperative Cobb measurements (43.4° vs. 47.1°; p =.2) as well. The number of fusion levels was 9 in the A/P group and 12 in the post-only group; the difference yielded significance (p =.02). Conclusions The A/P and post-only approaches averaged similar degrees of correction. The A/P patients were likely to correct more than their preoperative HE sagittal Cobb measurement, whereas the post-only group corrected close to their preoperative HE measurement. The number of fusion levels was larger with the post-only group.