General Session: Pediatric Spine - Hall F

Presented by: P. Passias

Author(s):

P. Passias(1), S. Horn(1), G. Poorman(1), J. Tishelman(1), J. Moon(1), B. Beaubrun(1), P. Zhou(1), L. Steinmetz(1), C. Bortz(1), F. Segreto(1), N. Frangella(1), M. Vaynrub(1), D. Vasquez-Montes(1), B. Diebo(2), S. Vira(1), M. Raad(3), D. Sciubba(3), V. Lafage(4), F. Schwab(4), T. Errico(1)

(1) New York University Langone Orthopedic Hospital, Division of Spinal Surgery, New York, NY, United States
(2) SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, United States
(3) Johns Hopkins University, Department of Neurosurgery, Baltimore, MD, United States
(4) Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, NY, United States

Abstract

Introduction: Scheuermann's Kyphosis (SK) is one of the most common causes of back pain in adolescents. Trends in diagnoses and surgical treatment and approach to SK have not been well described. The aim of this study was to evaluate the impact of advances in spinal surgery on patient outcomes in the treatment of Scheuermann's Kyphosis.

Methods: Retrospective review of KID Inpatient Database(KID) from the years 2003, 2006, 2009, 2012. SK patients ages 0-20 in KID were identified by ICD-9 code 732.0. KID-supplied year- and hospital-trend weights were used to establish prevalence. Patient demographics, surgical details, and outcomes were analyzed with ANOVA.

Results: 1070 SK patients were identified (33.2% female), with increasing incidence of SK diagnosed from 2003-2012(3.6-7.5 per 100,000, p< 0.001). The average age of operative patients was 16.1±2.0 years and did not change(16.27-16.06 years, p=0.905). The rate of surgery has not changed over time(72.8%-72.8%, p=0.909). 96.3% of operative patients underwent fusion, with 82.2% of cases spanning ≥4 levels. 8.6% underwent an anterior-only surgery, 74.6% posterior-only, and 13.6% a combined approach. From 2003-2012, rates of posterior-only surgeries increased (62.4%-84.4%, p< 0.001) while the rate of combined approach surgeries decreased over time(37.6%-8.8%, p< 0.001). Overall complication rates for SK surgeries have decreased(2003: 35.2%, 2012: 21.8%, p=0.029). Concurrently, the rate of 4+ level fusions has increased (43.5%-89.6%, p< 0.001), as well as the use of Smith Peterson (7.8%-23.6%, p< 0.001) and 3-column osteotomies (0.0%-2.7%, p=0.011). In sub-analysis comparing posterior to combined approaches, complication rates were significantly different (Posterior: 9.88%, Combined: 19.46%, p=0.005). Patients undergoing a combined approach have longer length of stay (LOS) than patients undergoing a posterior-only approach (7.8 v 5.6 days, p< 0.001).

Conclusions: Despite unchanged demographics and operative rates in SK, there has been a shift from combined to isolated posterior approaches, with a concurrent increase in levels treated. A combined approach was associated with increased complication rates, LOS, and total charges compared to isolated approaches. Awareness of these inherent differences is important for surgical decision making and patient education.