Minimum five-year follow-up of posterior-only pedicle screw constructs for thoracic and thoracolumbar kyphosis

Study design: Retrospective cohort study. Objective: To review/report 5-year follow-up data on patients diagnosed with thoracic and thoracolumbar kyphosis (TK/TLK) treated with posterior-only spinal fusion. Summary of background data: TK/TLK was initially treated with combined anterior/posterior spinal fusion, evolving into widespread treatment with posterior-only spinal fusion. Methods: Forty-three patients who underwent a posterior-only spinal fusion for a primary diagnosis of TK/TLK from 1999 to 2009 with > 5-year follow-up were identified. Preoperative/postoperative/final follow-up measurements were recorded from full-length standing radiographs. Prospectively collected outcome scores were reviewed for the same time points, and charts were examined for complications. Results: Patient age averaged 33 years (range 13–77), and follow-up averaged 5.6 years (range 5–12.2). Diagnoses included Scheuermann’s disease (N = 15, 35%), idiopathic (N = 10, 23%), pseudarthrosis (N = 6, 14%), iatrogenic (N = 4, 9%), degenerative (N = 3, 7%), post-traumatic (N = 3, 7%), and congenital kyphosis (N = 2, 5%). Average correction of 44.3° (46%; 92.8° preoperatively vs 48.5° postoperatively) was achieved through posterior-only surgery. Loss of correction averaged only 1° in the instrumented segments at final follow-up. Eleven patients had a complication; proximal junctional kyphosis was the most common (N = 3, 7%). One patient lost intraoperative monitoring and one had temporary neurological deterioration postoperatively, but there was no permanent deficit. No pseudarthroses occurred. ODI scores improved 17.2 points on average (p = 0.01). SRS scores improved in all domains (average 0.79, p < 0.001). Conclusion: Pedicle screw constructs permit effective posterior-only correction of TK/TLK that is maintained at the 5-year follow-up time point. Patients report improvement, via outcome questionnaires, at the same follow-up time points. Graphic abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]