Comparison of clinical and radiological outcomes of SRS-Schwab grade 3-4 and SRS-Schwab 5-6 osteotomies in congenital kyphosis and kyphoscoliosis patients.

Objective: This study aimed to evaluate the clinical and radiological outcomes of two patient groups with congenital kyphosis and kyphoscoliosis who underwent posterior surgical correction using Schwab grade 3-4 and Schwab grade 5-6 osteotomies.

Methods: A retrospective analysis was conducted on 58 patients (35 females and 23 males; mean age: 16.2 yr). Radiological evaluations included preoperative,postoperative,and last follow-up measurements of segmental kyphosis, scoliosis, lumbar lordosis(LL), C7-central sacral vertical line[C7-CSVL] and sagittal vertical axis [SVA], and pelvic parameters (pelvic incidence [PI],pelvic tilt [PT], sacral slope [SS].Clinical evaluations included Scoliosis Research Society-22r (SRS-22r) scores and Oswestry Disability Index (ODI) scores at preoperative and last follow-up time points.

Results: The mean deformity correction was 53.4%. Preoperative segmental kyphosis angles for Schwab grade 3-4 osteotomy (group 1) and Schwab grade 5-6 osteotomy (group 2) were 66.9° and 104.9°, respectively.The last follow-up angles were 33.1° and 48.2° (p < 0.001).No significant loss of correction was observed in either group (p > 0.05). SRS-22r scores improved significantly at the last follow-up (p < 0.001).Similarly, ODI scores improved significantly in both groups (p < 0.001).Neurological complications occurred in 14 (24.1%) patients,including dura injury, spinal nerve root injury, transient incomplete neurological deficits, and spinal cord compression.Mechanical complications were reported in 14 (24.1%) patients and included rod fractures, proximal junction kyphosis, pedicle screw malposition, and pedicle screw loosening.

Conclusions: Posterior surgical correction using Schwab grade 3-4 and Schwab grade 5-6 osteotomies yields satisfactory radiological and clinical outcomes in patients with congenital kyphosis and kyphoscoliosis. However, higher osteotomy grades, necessitated by greater deformity severity, are associated with increased complication rates.