Two-stage anterior and posterior fusion versus one-stage posterior fusion in patients with Scheuermann's kyphosis

Bone Joint J. 2020 Oct;102-B(10):1368-1374. doi: 10.1302/0301-620X.102B10.BJJ-2020-0273.R3.


Aims: Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann's kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion.

Methods: A retrospective review of patients treated surgically for Scheuermann's kyphosis between 2006 and 2014 was performed. A total of 62 patients were identified, with 31 in each group. Parameters were compared to evaluate postoperative outcomes using chi-squared tests, independent-samples t-tests, and z-tests of proportions analyses where applicable.

Results: There were six postoperative infections in the two-stage anteroposterior group compared with three in the one-stage posterior-only group. A total of four patients in the anteroposterior group required revision surgery, compared with six in the posterior-only group. There was a significantly higher incidence of junctional failure associated with the one-stage posterior-only approach (12.9% vs 0%, p = 0.036). Proximal junction kyphosis (anteroposterior fusion (74.2%) vs posterior-only fusion (77.4%); p = 0.382) and distal junctional kyphosis (anteroposterior fusion (25.8%) vs posterior-only fusion (19.3%), p = 0.271) are common postoperative complications following both surgical approaches.

Conclusion: A two-stage anteroposterior fusion was associated with a significantly greater correction of the kyphosis compared with a one-stage posterior-only fusion, with a reduced incidence of junctional failure (0 vs 3). There was a notably greater incidence of infection with two-stage anteroposterior fusion; however, all were medically managed. More patients in the posterior-only group required revision surgery. Cite this article: Bone Joint J 2020;102-B(10):1368-1374.

Keywords: 1-stage surgery; 2-stage surgery; Complex spine surgery; Kyphosis; Scheuermann’s kyphosis; Spinal deformity; Spine surgery.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Humans
  • Male
  • Retrospective Studies
  • Scheuermann Disease / diagnostic imaging
  • Scheuermann Disease / surgery*
  • Spinal Fusion / methods*