Turkish Neurosurgery 2024 , Vol 34 , Num 3
Using Proximal Hooks as a Soft-Landing Strategy to Prevent Proximal Junctional Kyphosis in the Surgical Treatment of Scheuermann's Kyphosis
Alim Can BAYMURAT1,Aliekber YAPAR2,Mehmet Ali TOKGOZ1, Ismail DALDAL3,Yagiz Ogul AKCAN1,Alpaslan SENKOYLU1
1Gazi University Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Türkiye
2Health Sciences University, Antalya Education and Research Hospital, Department of Orthopaedics and Traumatology, Antalya, Türkiye
3Medicana International Istanbul - Beylikduzu, Department of Orthopaedics and Traumatology, Istanbul, Türkiye
DOI : 10.5137/1019-5149.JTN.45194-23.2 AIM: To evaluate the occurrence of proximal junctional kyphosis (PJK) as well as both the clinical and radiologic outcomes of patients who underwent surgery for Scheuermann?s Kyphosis (SK) using either exclusively pedicle screws or a combination of proximal hooks and pedicle screws constructs.

MATERIAL and METHODS: Surgically treated 37 patients with the diagnosis of SK were evaluated retrospectively. The patients were divided into two groups based on the type of instrumentation employed. The first group contained 22 patients with only pedicle screws (PP) while the second group consisted of 15 patients with mixed constructs that were proximal hooks and pedicle screws (HP) at the rest of the levels. The clinical and radiological data were compared in patients who were followed up for a minimum of 2 years.

RESULTS: The average duration of follow-up for the PP group was approximately 94.7 ± 53.1 months, whereas the HP group had an average follow-up period of around 103 ± 64.4 months. After conducting the analyses, no statistically significant findings were identified in the measurements taken for the SRS-22 scores in preoperative, postoperative, and the most recent follow-up radiographs (p>0.05). It is worth noting that among patients who exclusively utilized pedicle screws, both the proximal (p=0.045) and distal (p=0.030) junctional kyphosis angles experienced more pronounced increases compared to hybrid structures.

CONCLUSION: While no notable distinction was observed between the two groups, patients with pedicle screws fixation had a higher PJK angle. Conversely, the use of hooks at the upper end seems to be a preventive measure against the development of PJK. Keywords : Scheuermann?s kyphosis, Proximal junctional kyphosis, Hook fixation, Pedicle screw

Corresponding author : Alpaslan SENKOYLU, drsenkoylu@gmail.com