National Trends in Spinal Fusion Surgery For Scheuermann Kyphosis

Study DesignAnalysis of a national database.ObjectiveTo analyze national trends in spinal fusion surgery for Scheuermann kyphosis (SK) and to compare surgical approaches used in treatment.Summary of Background DataThe preferred surgical approach for treating SK is not well established. Recent studies support the use of posterior spinal fusion (PSF) instead of anterior-posterior spinal fusion (APSF).MethodsUsing the Nationwide Inpatient Sample database, we identified 2,796 patients (mean age, 24.9 years; 66% men) from 2000 to 2008 who had spinal fusion surgery for SK. We compared the two approaches with respect to patient demographics, institutional characteristics, in-hospital complications, and hospitalization lengths and costs. Significance was set at a value of p less than .05.ResultsThe number of spinal fusion surgeries performed in patients with SK increased significantly (p = .03). The proportion of patients undergoing surgery as adults also increased significantly (p < .05). The number of PSF surgeries performed in patients with SK increased 2.9-fold (34% to 78%) (p < .01); APSF use declined by 7% per year. There was no significant association among surgical approach and patient age, sex, hospital capacity, or teaching status. Compared with patients undergoing PSF, patients undergoing APSF had 2.1-fold more in-hospital complications (p < .01), 3.8-fold more pulmonary complications (p < .01), 2.7-fold more renal complications (p < .01), and significantly longer hospitalizations (mean, 8.5 days vs. 5.9 days, respectively; p < .01). There was no significant difference in mean total hospital charges: $117,921 for APSF and $119,322 for PSF.ConclusionThere have been significant increases in the number of spinal fusion surgeries for SK, and in the proportion of patients with SK who are choosing surgery as adults. Surgical treatment has shifted predominantly toward an all-posterior approach. PSF is associated with lower complication rates (especially pulmonary complications) and shorter hospitalizations.