Scheuermann's kyphosis carries higher perioperative risk than idiopathic scoliosis in adolescent patients undergoing posterior spinal fusion.

BACKGROUND: The purpose of this study was to compare perioperative outcomes between adolescents undergoing posterior spinal fusion for idiopathic scoliosis versus Scheuermann's kyphosis using a large clinical registry. METHODS: This was a retrospective cohort study using the NSQIP Pediatric database years 2016-2024. Patients aged 10-17 years who underwent posterior spinal fusion for either idiopathic scoliosis (AIS) or Scheuermann's kyphosis (SK) were included. Perioperative outcomes of interest included operative time, length of stay, allogeneic transfusion, any adverse event, unplanned readmission, unplanned reoperation, and postoperative neurological injury. Outcomes were compared between the two etiologies using Student's t-test and Chi-square test. Multivariable regression analyses were performed adjusting for age, gender, ASA score, and number of fusion levels. RESULTS: A total of 31,637 patients were included (AIS: 31,120, mean age 14.5 years; SK: 517, mean age 15.7 years). SK patients had significantly longer operative time (AIS: 276.4 min vs. SK: 306.4 min, p<0.001) and length of stay (AIS: 3.4 days vs. SK: 3.8 days, p = 0.03). SK patients had significantly higher rates of any adverse event (AIS: 1.6% vs. SK: 3.7%, p<0.001), unplanned reoperation (AIS: 1.3% vs. SK: 3.5%, p<0.001), unplanned readmission (AIS: 1.7% vs. SK: 5.6%, p<0.001), and postoperative neurological injury (AIS: 0.3% vs. SK: 1.4%, p<0.001). SK patients had a significantly lower rate of allogeneic transfusion (AIS: 10.9% vs. SK: 5.6%, p<0.001). On multivariable regression analysis, SK patients had higher odds of any adverse event (OR 1.72, p = 0.03), readmission (OR 2.24, p<0.001), reoperation (OR 1.88, p = 0.01), and postoperative neurological injury (OR 3.56, p = 0.002), as well as decreased odds of allogeneic transfusion (OR 0.44, p<0.001). Etiology was not independently associated with operative time or length of stay after adjustment. CONCLUSION: Adolescents undergoing posterior spinal fusion for Scheuermann's kyphosis experience significantly higher rates of perioperative complications, readmissions, reoperations, and neurological injury compared with those treated for idiopathic scoliosis. These findings highlight important differences in perioperative risk between pathologies and underscore the need for tailored preoperative counseling, risk stratification, and perioperative planning for patients with Scheuermann's kyphosis.