Posterior Surgery in Scheuermann's Kyphosis: A Retrospective Review of 210 Cases
Abstract
Background: Scheuermann’s kyphosis (SK), also known as juvenile kyphosis, is one of the most common causes of spinal deformity in adolescents. The objective of this study was to review the outcomes of posterior-only surgical correction for SK over 25 years.
Methods: We retrospectively reviewed patients diagnosed with SK who underwent posterior spinal surgery. Health-related quality of life was assessed using the Oswestry Disability Index (ODI) and the Scoliosis Research Society 30-item questionnaire (SRS-30), and radiographic parameters were evaluated preoperatively and at follow-up.
Results: A total of 210 patients with SKs underwent posterior-only surgical correction. The mean age at surgery was 17.5 years (range, 12–38 years), with a mean follow-up of 17.5 years. Significant improvements were observed in sagittal Cobb angle (85.9° to 43.2°, P < 0.001), coronal Cobb angle (32.5° to 11.5°, P < 0.001), L1–S1 lordosis (P = 0.001), and sagittal balance (P = 0.043). Clinical outcomes also improved significantly, with the ODI decreasing from 23.2 to 5.8 (P = 0.003) and the SRS-30 score increasing from 64 to 133.5 (P < 0.001). The mean pelvic incidence (PI) was 46°, with no significant correlation between pelvic incidence and either the preoperative sagittal Cobb angle (P = 0.46) or kyphosis correction (P = 0.7). However, kyphosis correction approximating PI was associated with more favorable postoperative outcomes. The overall complication rate was 4%, and the mean loss of correction at the final follow-up was 1.6°.
Conclusion: A posterior-only approach is an effective and safe treatment for SK; however, whether correction approximating PI can optimize individualized outcomes remains a hypothesis requiring prospective evaluation.
1. Bezalel T, Carmeli E, Been E, Kalichman L. Scheuermann's disease: current diagnosis and treatment approach. J Back Musculoskelet Rehabil. 2014;27(4):383-90. doi: 10.3233/bmr-140483. [PubMed: 24898440].
2. James J. Scheuermann's Juvenile Kyphosis. Clinical Appearances, Radiography, Aetiology, and Prognosis. J Bone Joint Surg Br. 1965;47-B(1):203. doi: 10.1302/0301-620X.47B1.203-a.
3. Blumenthal SL, Roach J, Herring JA. Lumbar Scheuermann's. A clinical series and classification. Spine (Phila Pa 1976). 1987;12(9):929-32. [PubMed: 3441839].
4. Azar FM, Canale ST, Beaty JH. Campbell's Operative Orthopaedics E-Book. Amsterdam, Netherlands: Elsevier Health Sciences; 2016.
5. Stambough JL, VanLoveren HR, Cheeks ML. Spinal cord compression in Scheuermann's kyphosis: case report. Neurosurgery. 1992;30(1):127-30. doi: 10.1227/00006123- 199201000-00025. [PubMed: 1738443].
6. Kapetanos GA, Hantzidis PT, Anagnostidis KS, Kirkos JM. Thoracic cord compression caused by disk herniation in Scheuermann's disease: a case report and review of the literature. Eur Spine J. 2006;15 Suppl 5(Suppl 5):553-8. doi: 10.1007/s00586-005-0053-0. [PubMed: 16421745]. [PubMed Central: PMC1602190].
7. Bradford DS, Moe JH, Montalvo FJ, Winter RB. Scheuermann's kyphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients. J Bone Joint Surg Am. 1975;57(4):439-48. [PubMed: 1141252].
8. Ponte A. Surgical treatment of Scheuermann's hyperkyphosis. Orthop Trans. 1985;9:127.
9. Lee SS, Lenke LG, Kuklo TR, Valenté L, Bridwell KH, Sides B, et al. Comparison of Scheuermann kyphosis correction by posterior- only thoracic pedicle screw fixation versus combined anterior/posterior fusion. Spine (Phila Pa 1976). 2006;31(20): 2316-21. doi: 10.1097/01.brs.0000238977.36165.b8. [PubMed: 16985459].
10. Bradford DS, Ahmed KB, Moe JH, Winter RB, Lonstein JE. The surgical management of patients with Scheuermann's disease: a review of twenty-four cases managed by combined anterior and posterior spine fusion. J Bone Joint Surg Am. 1980;62(5):705-12. [PubMed: 7391093].
11. Geck MJ, Macagno A, Ponte A, Shufflebarger HL. The Ponte procedure: posterior only treatment of Scheuermann's kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech. 2007;20(8): 586-93. doi: 10.1097/BSD.0b013e31803d3b16. [PubMed: 18046172].
12. Hosman AJ, Langeloo DD, de Kleuver M, Anderson PG, Veth RP, Slot GH. Analysis of the sagittal plane after surgical management for Scheuermann's disease: a view on overcorrection and the use of an anterior release. Spine (Phila Pa 1976). 2002;27(2):167-75. doi: 10.1097/00007632-200201150-00009. [PubMed: 11805663].
13. Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three- dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7(2):99-103. doi: 10.1007/s005860050038. [PubMed: 9629932]. [PubMed Central: PMC3611230].
14. Bernhardt M, Bridwell KH. Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine (Phila Pa 1976). 1989;14(7):717-21. doi: 10.1097/00007632-198907000-00012. [PubMed: 2772721].
15. Lowe TG, Kasten MD. An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann's disease. A review of 32 patients. Spine (Phila Pa 1976). 1994;19(15):1680-5. doi: 10.1097/00007632-199408000-00005. [PubMed: 7973960].
16. Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions. Spine (Phila Pa 1976). 2006;31(14):E454-9. doi: 10.1097/01.brs.0000222141.61424.f7. [PubMed: 16778675].
17. Ghandehari H, Mahabadi MA, Mahdavi SM, Shahsavaripour A, Seyed Tari HV, Safdari F. Evaluation of Patient Outcome and Satisfaction after Surgical Treatment of Adolescent Idiopathic Scoliosis Using Scoliosis Research Society-30. Arch Bone Jt Surg. 2015;3(2):109-13. [PubMed: 26110177]. [PubMed Central: PMC4468625].
18. Taylor TC, Wenger DR, Stephen J, Gillespie R, Bobechko WP. Surgical management of thoracic kyphosis in adolescents. J Bone Joint Surg Am. 1979;61(4):496-503. [PubMed: 438235].
19. Cho KJ, Lenke LG, Bridwell KH, Kamiya M, Sides B. Selection of the optimal distal fusion level in posterior instrumentation and fusion for thoracic hyperkyphosis: the sagittal stablevertebra concept. Spine (Phila Pa 1976). 2009;34(8):765-70. doi:
10.1097/BRS.0b013e31819e28ed. [PubMed: 19365243].
20. Papagelopoulos PJ, Klassen RA, Peterson HA, Dekutoski MB. Surgical treatment of Scheuermann's disease with segmental compression instrumentation. Clin Orthop Relat Res. 2001(386):139-49. doi: 10.1097/00003086-200105000-00018.
[PubMed: 11347827].
21. Johnston CE, Elerson E, Dagher G. Correction of adolescent hyperkyphosis with posterior-only threaded rod compression instrumentation: is anterior spinal fusion still necessary? Spine (Phila Pa 1976). 2005;30(13):1528-34. doi: 10.1097/01.brs.0000167672.06216.73. [PubMed: 15990668].
22. Etemadifar M, Ebrahimzadeh A, Hadi A, Feizi M. Comparison of Scheuermann's kyphosis correction by combined anterior- posterior fusion versus posterior-only procedure. Eur Spine J. 2016;25(8):2580-6. doi: 10.1007/s00586-015-4234-1. [PubMed: 26365711].
23. Sardar ZM, Ames RJ, Lenke L. Scheuermann's Kyphosis: Diagnosis, Management, and Selecting Fusion Levels. J Am Acad Orthop Surg. 2019;27(10):e462-e72. doi: 10.5435/jaaos-d-17-00748. [PubMed: 30407981].
24. Coe JD, Smith JS, Berven S, Arlet V, Donaldson W, Hanson D, et al. Complications of spinal fusion for scheuermann kyphosis: a report of the scoliosis research society morbidity and mortality committee. Spine (Phila Pa 1976). 2010;35(1):99-103. doi: 10.1097/BRS.0b013e3181c47f0f. [PubMed: 20042960].
25. Mac-Thiong JM, Transfeldt EE, Mehbod AA, Perra JH, Denis F, Garvey TA, et al. Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976). 2009;34(15):E519-27. doi: 10.1097/BRS.0b013e3181a9c7ad. [PubMed: 19564757].
26. Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005;30(6):682-8. doi: 10.1097/01.brs.0000155425.04536.f7. [PubMed: 15770185].
27. Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, et al. Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine (Phila Pa 1976). 2011;36(10):817-24. doi: 10.1097/BRS.0b013e3181e21783. [PubMed: 20683385].
28. Tyrakowski M, Mardjetko S, Siemionow K. Radiographic spinopelvic parameters in skeletally mature patients with Scheuermann disease. Spine (Phila Pa 1976). 2014;39(18):E1080-5. doi: 10.1097/brs.0000000000000460. [PubMed: 24921842].
29. Jiang L, Qiu Y, Xu L, Liu Z, Wang Z, Sha S, et al. Sagittal spinopelvic alignment in adolescents associated with Scheuermann's kyphosis: a comparison with normal population. Eur Spine J. 2014;23(7):1420-6. doi: 10.1007/s00586- 014-3266-2. [PubMed: 24639080].
30. Cahill PJ, Steiner CD, Dakwar E, Trobisch PD, Lonner BS, Newton PO, et al. Sagittal Spinopelvic Parameters in Scheuermann's Kyphosis: A Preliminary Study. Spine Deform. 2015;3(3):267-71. doi: 10.1016/j.jspd.2014.11.001. [PubMed: 27927469].
2. James J. Scheuermann's Juvenile Kyphosis. Clinical Appearances, Radiography, Aetiology, and Prognosis. J Bone Joint Surg Br. 1965;47-B(1):203. doi: 10.1302/0301-620X.47B1.203-a.
3. Blumenthal SL, Roach J, Herring JA. Lumbar Scheuermann's. A clinical series and classification. Spine (Phila Pa 1976). 1987;12(9):929-32. [PubMed: 3441839].
4. Azar FM, Canale ST, Beaty JH. Campbell's Operative Orthopaedics E-Book. Amsterdam, Netherlands: Elsevier Health Sciences; 2016.
5. Stambough JL, VanLoveren HR, Cheeks ML. Spinal cord compression in Scheuermann's kyphosis: case report. Neurosurgery. 1992;30(1):127-30. doi: 10.1227/00006123- 199201000-00025. [PubMed: 1738443].
6. Kapetanos GA, Hantzidis PT, Anagnostidis KS, Kirkos JM. Thoracic cord compression caused by disk herniation in Scheuermann's disease: a case report and review of the literature. Eur Spine J. 2006;15 Suppl 5(Suppl 5):553-8. doi: 10.1007/s00586-005-0053-0. [PubMed: 16421745]. [PubMed Central: PMC1602190].
7. Bradford DS, Moe JH, Montalvo FJ, Winter RB. Scheuermann's kyphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients. J Bone Joint Surg Am. 1975;57(4):439-48. [PubMed: 1141252].
8. Ponte A. Surgical treatment of Scheuermann's hyperkyphosis. Orthop Trans. 1985;9:127.
9. Lee SS, Lenke LG, Kuklo TR, Valenté L, Bridwell KH, Sides B, et al. Comparison of Scheuermann kyphosis correction by posterior- only thoracic pedicle screw fixation versus combined anterior/posterior fusion. Spine (Phila Pa 1976). 2006;31(20): 2316-21. doi: 10.1097/01.brs.0000238977.36165.b8. [PubMed: 16985459].
10. Bradford DS, Ahmed KB, Moe JH, Winter RB, Lonstein JE. The surgical management of patients with Scheuermann's disease: a review of twenty-four cases managed by combined anterior and posterior spine fusion. J Bone Joint Surg Am. 1980;62(5):705-12. [PubMed: 7391093].
11. Geck MJ, Macagno A, Ponte A, Shufflebarger HL. The Ponte procedure: posterior only treatment of Scheuermann's kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech. 2007;20(8): 586-93. doi: 10.1097/BSD.0b013e31803d3b16. [PubMed: 18046172].
12. Hosman AJ, Langeloo DD, de Kleuver M, Anderson PG, Veth RP, Slot GH. Analysis of the sagittal plane after surgical management for Scheuermann's disease: a view on overcorrection and the use of an anterior release. Spine (Phila Pa 1976). 2002;27(2):167-75. doi: 10.1097/00007632-200201150-00009. [PubMed: 11805663].
13. Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three- dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7(2):99-103. doi: 10.1007/s005860050038. [PubMed: 9629932]. [PubMed Central: PMC3611230].
14. Bernhardt M, Bridwell KH. Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine (Phila Pa 1976). 1989;14(7):717-21. doi: 10.1097/00007632-198907000-00012. [PubMed: 2772721].
15. Lowe TG, Kasten MD. An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann's disease. A review of 32 patients. Spine (Phila Pa 1976). 1994;19(15):1680-5. doi: 10.1097/00007632-199408000-00005. [PubMed: 7973960].
16. Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions. Spine (Phila Pa 1976). 2006;31(14):E454-9. doi: 10.1097/01.brs.0000222141.61424.f7. [PubMed: 16778675].
17. Ghandehari H, Mahabadi MA, Mahdavi SM, Shahsavaripour A, Seyed Tari HV, Safdari F. Evaluation of Patient Outcome and Satisfaction after Surgical Treatment of Adolescent Idiopathic Scoliosis Using Scoliosis Research Society-30. Arch Bone Jt Surg. 2015;3(2):109-13. [PubMed: 26110177]. [PubMed Central: PMC4468625].
18. Taylor TC, Wenger DR, Stephen J, Gillespie R, Bobechko WP. Surgical management of thoracic kyphosis in adolescents. J Bone Joint Surg Am. 1979;61(4):496-503. [PubMed: 438235].
19. Cho KJ, Lenke LG, Bridwell KH, Kamiya M, Sides B. Selection of the optimal distal fusion level in posterior instrumentation and fusion for thoracic hyperkyphosis: the sagittal stablevertebra concept. Spine (Phila Pa 1976). 2009;34(8):765-70. doi:
10.1097/BRS.0b013e31819e28ed. [PubMed: 19365243].
20. Papagelopoulos PJ, Klassen RA, Peterson HA, Dekutoski MB. Surgical treatment of Scheuermann's disease with segmental compression instrumentation. Clin Orthop Relat Res. 2001(386):139-49. doi: 10.1097/00003086-200105000-00018.
[PubMed: 11347827].
21. Johnston CE, Elerson E, Dagher G. Correction of adolescent hyperkyphosis with posterior-only threaded rod compression instrumentation: is anterior spinal fusion still necessary? Spine (Phila Pa 1976). 2005;30(13):1528-34. doi: 10.1097/01.brs.0000167672.06216.73. [PubMed: 15990668].
22. Etemadifar M, Ebrahimzadeh A, Hadi A, Feizi M. Comparison of Scheuermann's kyphosis correction by combined anterior- posterior fusion versus posterior-only procedure. Eur Spine J. 2016;25(8):2580-6. doi: 10.1007/s00586-015-4234-1. [PubMed: 26365711].
23. Sardar ZM, Ames RJ, Lenke L. Scheuermann's Kyphosis: Diagnosis, Management, and Selecting Fusion Levels. J Am Acad Orthop Surg. 2019;27(10):e462-e72. doi: 10.5435/jaaos-d-17-00748. [PubMed: 30407981].
24. Coe JD, Smith JS, Berven S, Arlet V, Donaldson W, Hanson D, et al. Complications of spinal fusion for scheuermann kyphosis: a report of the scoliosis research society morbidity and mortality committee. Spine (Phila Pa 1976). 2010;35(1):99-103. doi: 10.1097/BRS.0b013e3181c47f0f. [PubMed: 20042960].
25. Mac-Thiong JM, Transfeldt EE, Mehbod AA, Perra JH, Denis F, Garvey TA, et al. Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976). 2009;34(15):E519-27. doi: 10.1097/BRS.0b013e3181a9c7ad. [PubMed: 19564757].
26. Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005;30(6):682-8. doi: 10.1097/01.brs.0000155425.04536.f7. [PubMed: 15770185].
27. Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, et al. Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine (Phila Pa 1976). 2011;36(10):817-24. doi: 10.1097/BRS.0b013e3181e21783. [PubMed: 20683385].
28. Tyrakowski M, Mardjetko S, Siemionow K. Radiographic spinopelvic parameters in skeletally mature patients with Scheuermann disease. Spine (Phila Pa 1976). 2014;39(18):E1080-5. doi: 10.1097/brs.0000000000000460. [PubMed: 24921842].
29. Jiang L, Qiu Y, Xu L, Liu Z, Wang Z, Sha S, et al. Sagittal spinopelvic alignment in adolescents associated with Scheuermann's kyphosis: a comparison with normal population. Eur Spine J. 2014;23(7):1420-6. doi: 10.1007/s00586- 014-3266-2. [PubMed: 24639080].
30. Cahill PJ, Steiner CD, Dakwar E, Trobisch PD, Lonner BS, Newton PO, et al. Sagittal Spinopelvic Parameters in Scheuermann's Kyphosis: A Preliminary Study. Spine Deform. 2015;3(3):267-71. doi: 10.1016/j.jspd.2014.11.001. [PubMed: 27927469].
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| Issue | Vol 12 No 4 (2026) | |
| Section | Research Articles | |
| Keywords | ||
| Scheuermann Disease Spine Surgery | ||
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How to Cite
1.
Safaei S, Yazdanian T, Azimi P. Posterior Surgery in Scheuermann’s Kyphosis: A Retrospective Review of 210 Cases. J Orthop Spine Trauma. 2026;12(4):174-8.
