Selection Of The Optimal Level Of Distal Fixation For Correction Of Scheuermann's Hyperkyphosis.

OBJECTIVE To analyze the efficacy of the method for selecting the distal level of fusion in treatment of thoracic hyperkyphosis in patients with Scheuermann's disease. BACKGROUND The fusion area needs to include all the kyphotic deformity in Scheuermann patients; however, precise levels of the distal fixation have not been determined yet. STUDY DESIGN Retrospective cohort review. MATERIALS AND METHODS Thirty-six patients were operated in the Department of Children and Adolescent Spine Pathology between 2007 and 2010. These patients were divided into two groups: in group I (n = 29) a lower instrumented vertebra corresponded to the sagittal stable one and in group II (n = 7) - this vertebra located proximally. RESULTS The mean preoperative kyphosis was 79.3° ± 11.6°, the postoperative - 40.6° ± 11.9° (correction of 49.9%), loss of correction was 4.9° ± 7.0°. Sagittal balance changed from -0.3 ± 3.2 cm before surgery to -1.7 ± 2.1 cm after surgery. Distal junctional kyphosis developed in 1 case (4%) in Group I, and in 5 cases (71%) in Group II. CONCLUSION A distal level of instrumentation ending at the first lordotic vertebra is not justified and causes violation of sagittal balance and development of distal junctional kyphosis. The inclusion of a sagittal stable vertebra in fusion prevents the development of this undesirable situation.