Combined Anterior-Posterior Versus Posterior-only Spinal Fusion in Treating Dystrophic Neurofibromatosis Scoliosis With Modern Instrumentation

Abstract

This is a systematic review and meta-analysis study.Objectives: To compare the efficacy, long-term stability, and safety of combined anterior-posterior spinal fusion (APSF) with posterior-only spinal fusion (PSF) in treating dystrophic neurofibromatosis scoliosis with the use of modern instrumentation.Summary of Background Data: When the Harrington or Luque technique was used, APSF had relatively reliable results and had been recommended by many authors. But with the development of instrumentation and techniques, many surgeons performed PSF with satisfactory results. No systematic review and metaanalysis have been conducted to compare the outcomes of the 2 approaches. Materials and Methods:Relevant studies on anterior-posterior or posterior fusion of dystrophic neurofibromatosis scoliosis were retrieved from the PubMed, Embase, Cochrane, Springer Link, and Google Scholar databases. Then studies were manually selected for inclusion based on predefined criteria. Data extraction and quality assessment were conducted, and a systematic review and meta-analysis were performed.Results: Sixteen eligible studies were included. The angles of scoliosis curves and kyphosis curves were significantly and similarly corrected after surgery in both APSF and PSF group, respectively. At the last follow-up, the loss of correction was significant in the coronal plane but not in the sagittal plane with a similar progression of scoliosis in 2 groups. The overall complication rate was slightly higher in the APSF group, but the difference was not statistically significant. Meanwhile, there was no visible difference in the incidence of pseudarthrosis and instrumentation failures between the 2 groups.Conclusions: APSF and PSF by means of the third-generation spinal instrumentation system have similar efficacy, long-term stability, and safety for treating dystrophic scoliosis secondary to type-1 neurofibromatosis.

Bone Lesions in Children with Neurofibromatosis

“…High incidence of pseudoarthrosis in dystrophic curves have been reported, rising up to 60% in older reports [1]. Complication rate after surgery in children with dystrophic curves is expected to be higher than those surgically treated for idiopathic scoliosis [13,14]. But recently, with the improvement of the procedures, Lyu et al [15] report similar good results for both groups, with no fusion failure and similar rate of complications between the 2 groups.…”

Análise comparativa entre as abordagens cirúrgicas por via posterior isolada e por via anteroposterior para tratamento de escoliose severa

“…O uso de instrumentação segmentar tem sido aprimorado, a princípio com fios de Luque, e após, com ganchos múltiplos e instrumentação híbrida. [6][7][8][9][10] Recentemente, foram criadas bandas sublaminares, com ação semelhante aos fios sublaminares e que agregam, em casos selecionados, na correção da escoliose associadas aos parafusos pediculares. 3 As construções atuais utilizam parafusos pediculares em coluna lombar e torácica, tornando-se grandes aliados na correção de deformidades.…”

“…O uso de instrumentação segmentar tem sido aprimorado, a princípio com fios de Luque, e após, com ganchos múltiplos e instrumentação híbrida. 6 7 8 9 10 …”