Surgical outcomes in adult scheuermann's kyphosis: a matched-cohort comparison with adult idiopathic scoliosis as a clinical benchmark.

PURPOSE: Surgical treatment for Scheuermann's Kyphosis (SK) in adolescents is well-established, but its role in adults remains controversial. This study challenges the traditional non-operative stance by evaluating the clinical outcomes of surgery in adult SK patients, using a matched cohort of adult idiopathic scoliosis (Adult IS) patients as a clinical benchmark.

METHODS

A retrospective, 1:3 matched-cohort study from a multicenter database with a minimum 2-year follow-up. Thirty-three SK patients were matched with 99 Adult IS patients by age and number of instrumented levels. Demographics, radiographic parameters, surgical data, complications, and patient-reported outcome measures (PROMs) were analyzed.

RESULTS

33 SK patients and 99 patients from the Adult IS comparative cohort were included. Mean age was 32.1 years; 82.8% of Adult IS patients and 39.4% of SK patients were female. Mean preoperative kyphosis in SK was 74.9°, and the mean Cobb angle in Adult IS was 66.3°. The SK cohort presented with significantly worse baseline mental health scores (p = 0.015). Despite requiring more posterior column osteotomies (51.5% vs. 27.2%, p = 0.012), the SK cohort showed no significant increase in surgical time or blood loss. Both groups improved in all PROMs, with significantly greater mental health gains in SK (p = 0.03). Major complications (21.2% vs. 19.2%, p = 0.790) and reinterventions (21.2% vs. 18.2%, p = 0.719) were comparable.

CONCLUSION

Surgical correction of Scheuermann's kyphosis in young adults is safe and effective, leading to significant functional and psychological improvements, particularly in mental health. Complication rates and surgical complexity were comparable to adult idiopathic scoliosis surgery. Surgical treatment is a viable option for appropriately selected adult SK patients.

LEVEL OF EVIDENCE: III.