Anterior versus posterior approach in Lenke 5C adolescent idiopathic scoliosis: a meta-analysis of fusion segments and radiological outcomes

Abstract

BackgroundRadiological outcomes between anterior and posterior approach in Lenke 5C curves were still controversial. Meta-analysis on published articles to compare fusion segments and radiological outcomes between the two surgical approaches was performed.MethodsElectronic database was conducted for searching studies concerning the anterior versus posterior approach in Lenke 5C curves. After quality assessment, data of means, standard deviations, and sample sizes were extracted. RevMan 5.3 was adopted for data analysis.ResultsSeven case-control studies involving 308 Lenke 5C AIS patients were identified in the meta-analysis. No significant differences were noted in correction rate of thoracolumbar/lumbar curve (95 % CI −6.02 to 4.32, P = 0.75) and incidence of proximal junctional kyphosis (95 % CI 0.12 to 7.19, P = 0.94) of final follow-up, in change values of thoracolumbar/lumbar curve (95 % CI −3.28 to 7.19, P = 0.46) and thoracic kyphosis (95 % CI −4.10 to 0.13, P = 0.07). The anterior approach represented a significant shorter fusion segments compared to posterior approach (95 % CI −1.72 to −0.71, P < 0.00001). The posterior approach obtained a larger increasing Cobb angle of lumbar lordosis than the anterior approach (95 % CI −6.06 to −0.61, P = 0.02).ConclusionsThe anterior and posterior approach can obtain comparable coronal correction, change values of thoracic kyphosis, and incidence of proximal junctional kyphosis. The anterior approach saves approximate one more fusion segment, and the posterior approach can obtain a larger increasing Cobb angle of lumbar lordosis, from preoperation to final follow-up.Trial registrationThe article type of this study is meta-analysis and prospective registration is not required.

Effectiveness and safety of surgical interventions for treating adolescent idiopathic scoliosis: a Bayesian meta-analysis

“…Previous studies focused on discussing the coronal plane correction between anterior and posterior surgery. Luo et al [56] reported that the posterior ASR + PSF combined anterior release and posterior fusion with instrumentation, VAT+PSF combined video assisted anterior release and posterior fusion with instrumentation without thoracoplasty, PSF posterior fusion with instrumentation without thoracoplasty, ASF anterior fusion with instrumentation and thoracotomy without thoracoplasty, VAT video assisted anterior fusion with instrumentation without thoracoplasty, W-T any scoliosis surgery with additional thoracoplasty or multiple convex rib resections, FEV1 forced expiratory volume in 1 s, FVC forced vital capacity approach can obtain a larger change of Cobb angle from pre-operation to final follow-up. Franic et al [17] found that both anterior and posterior surgeries provided a similar degree of reduction of frontal Cobb angle, and long-term effects of surgical correction on the sagittal Cobb angle seemed to be more stable in posterior group.…”

Current concepts in the diagnosis and management of adolescent idiopathic scoliosis

“…Although there are no reported differences in blood loss, length of hospital stay and patient reported outcomes between both approaches, the posterior approach may save on the negative impacts of the anterior approach on pulmonary function. Studies also showed that the posterior-only approach has the same correction as a combined anterior/posterior spinal fusion, without the need for entering the thorax and thus negatively impacting pulmonary function [57][58][59][60][61][62][63][64][65][66][67][68][69][70][71].…”

Posterior Spinal Fusion With Multilevel Posterolateral Convex Disc Releases for the Treatment of Severe Thoracolumbar Scoliosis

“…PCDR has the potential to preserve a distal level, as reported in some anterior procedures, and improves coronal imbalance by 52%. 35,36 A distal fusion level was saved in 2 of our 4 patients: one fused cephalad to the CEV and the other one cephalad of the touched and stable vertebrae. One patient was fused 1 level caudal to the CEV because of the presence of disc degeneration at the intervertebral disc caudal to the CEV.…”