What is the prognosis of kyphosis?

Updated: May 04, 2020
  • Author: R Carter Cassidy, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Results of treatments vary, depending on the etiology of the deformity.

Malcolm et al reviewed 48 patients and achieved a deformity correction rate of 26% and at least partial pain relief in 98% of patients with posttraumatic kyphosis with anterior and/or posterior fusions. [8]

Lehmer et al studied 38 patients who underwent a single-stage closing wedge procedure to treat posttraumatic and postlaminectomy kyphosis. [15] They obtained a mean correction of 35° with three pseudarthroses. Eight of 14 preoperative neurologic deficits improved, and 76% of the patients treated said they would undergo the surgery again if needed.

Kostuick achieved fusion in 36 of 37 patients receiving anterior-only fusion. [16] Pain significantly improved in 78%, and three of eight patients with paraparesis improved.

Outcomes in Scheuermann kyphosis are similar to those just presented, though the amount of correction achieved may not be correlated with pain relief.

In a series of patients who were treated with a posterior Harrington rod, all had pain relief. However, 16 of 22 lost correction. [17]

Lowe and Kasten used posterior instrumentation to achieve a mean correction of 85° down to 43°. [18]

With anterior-posterior and posterior-only surgery, Speck and Chopin gained an average deformity correction of 40%, and 28 of 45 patients were pain-free. [19]  However, four patients had infections, nine lost more than 10° of correction, and one had Brown-Sequard syndrome postoperatively.

Investigators have evaluated advanced techniques, such as osteotomies and new instrumentation. Bridwell et al reported a series of 33 patients treated with pedicle subtraction osteotomy for sagittal imbalance. [20, 21]  The C7 plumb line improved from 16.6 cm positive to 1.7 cm. Pain and Oswestry disability indexes significantly improved. Eight patients had pseudarthrosis, and one had a wound infection. No permanent neurologic injuries occurred.

In a retrospective study, anterior-posterior correction was compared with posterior-only instrumentation with all pedicle screws. [22]  The posterior-only group had significant improvement in terms of blood loss, correction of deformity, and number of complications.

Video-assisted thoracoscopic release followed by posterior arthrodesis has been successful. In one study, deformity correction was 84.8° to 45.3° in patients with thoracic kyphosis associated with Scheuermann disease. [23] Mean loss of correction was 1.6°, and one hook pulled out. No cases of junctional kyphosis were observed.

A 2019 systematic review of treatment of Scheuermann kyphosis demonstrated that most surgeons are moving from anterior and posterior approaches to posterior-only. Nonoperative treatment with bracing and therapy was notable for inferior correction and maintenance of correction, as opposed to surgical treatment. [24]


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