Comparison of combined anterior–posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis

Chen, Zihao; Rong, Limin

doi:10.1007/s00586-015-3968-0

Cited by 49 publications

(28 citation statements)

References 30 publications

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“…20 Nevertheless, newer techniques have allowed for similar results in terms of degree of correction and outcomes for posterior-only approaches, with less postoperative morbidity, lower blood loss, and shorter stay. 5 Though construct length 29 and osteotomy 6,21 have been associated with higher rates of adverse events in corrective surgery for adult scoliosis, we found no evidence of these associations for the AIS patients in the present study. Daubs et al noted that once the fusion length reaches 5 or more levels in adult spinal deformity, the addition of more segments may not necessarily increase complication rates, 8 and since AIS patients generally have more than 5 levels fused, it is possible that Daubs et al's finding also applies to the AIS population.…”

Section: Discussioncontrasting

confidence: 73%

Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample

Ramos¹,

Goodwin²,

Abu-Bonsrah³

et al. 2016

PED

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OBJECTIVE The aim of this study was to investigate the incidence of and factors associated with complications following idiopathic scoliosis surgery in adolescents. METHODS The Nationwide Inpatient Sample database was used to identify patients 10-18 years of age who had undergone spinal fusion for adolescent idiopathic scoliosis (AIS) from 2002 to 2011. Twenty-three unique in-hospital postoperative complications, including death, were examined. A series of logistic regressions was used to determine if any demographic, comorbid, or surgical parameter was associated with complication development. Results of multiple logistic regression analyses were reported as odds ratios with 95% confidence intervals. All analyses were performed after the application of discharge weights to produce national estimates. RESULTS A total of 36,335 patients met the study inclusion criteria, 7.6% of whom (95% CI 6.3%-8.9%) developed at least one in-hospital complication. The 3 most common complications were respiratory failure (3.47%), reintubation (1.27%), and implant related (1.14%). Major complications such as death, pancreatitis, disseminated intravascular coagulation, visual loss, spinal cord injury, cardiac arrest, sepsis, nerve root injury, deep vein thrombosis, pulmonary embolism, shock, malignant hyperthermia, myocardial infarction, and iatrogenic stroke each had an incidence ≤ 0.2%. On multiple logistic regression analysis, an increasing age (OR 0.80) was associated with significantly lower odds of complication development; patients who were male (OR 1.80) or who had anemia (OR 2.10), hypertension (OR 2.51), or hypothyroidism (OR 2.27) or underwent revision procedures (OR 5.55) were at a significantly increased risk for complication development. The rates of postoperative complications for posterior, anterior, and combined approaches were 6.7%, 10.0%, and 19.8%, respectively (p < 0.001). Length of fusion (< 8 vs ≥ 8 levels) was not associated with complication development (p = 0.311). CONCLUSIONS Analysis of 36,335 patients who had undergone surgery for AIS revealed that younger patients, male patients, patients with a history of anemia, hypertension, or hypothyroidism, as well as those undergoing revision or anterior or combined approaches may have higher rates of postoperative complications. However, the overall complication rate was low (7.6%), and major complications had a rate ≤ 0.2% for each event. These findings suggest that surgery for AIS remains relatively safe, and future prospective investigations may further help to decrease the postoperative morbidity rate.

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Section: Discussioncontrasting

confidence: 73%

Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample

Ramos¹,

Goodwin²,

Abu-Bonsrah³

et al. 2016

PED

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“…15 There are, however, disadvantages of combined anterior release, including the learning curve for the surgeon, cardiopulmonary compromise, adjacent-organ injuries, increased hospital stay and cost, halo traction complications before posterior procedures, and having the anesthesia risks of 2 major operations. 14,16 The main problem of the combined anterior and posterior procedure is the risk of pulmonary complica-tions. 6,17,18 Some studies have used preoperative traction or traction between 2 stages of surgery as a part of correction.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report

2020

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Background: The management of severe scoliosis may lead to significant complications, and adequate mobilization is a key step to achieve maximal correction, usually requiring extensive approaches. There is still no consensus on the management of these severe and rigid curves. In this study we evaluated the clinical and radiologic outcome of a posterior-only approach with multilevel asymmetric Ponte osteotomy with a minimum of 2 years' followup.Methods: In this retrospective study, 23 patients with severe and rigid adolescent idiopathic scoliosis who underwent surgery with a single-staged posterior-only approach were included. The surgical procedures in these patients were excision of posterior ligaments and spinous process, partial laminectomy in caudal part of lamina, excision of the ligamentum flavum, facetectomies, and multilevel asymmetric posterior column osteotomies (Ponte) followed by instrumented fusion. Clinical records-including demographic data; operating time; hospitalization time; blood loss; number of segments instrumented, fused, and osteotomized; functional improvement; follow-up duration; and complications-were recorded.Results: The mean preoperative Cobb angle of major curve in coronal plan was 97.58 (range, 828-1318) with the mean flexibility of 21.48 (range, 108-258) on bending radiography. The mean immediate postoperative Cobb angle of major curve was 34.88 (range, 178-618), showing a 64.2% correction. The mean preoperative coronal and sagittal imbalances of 3.8 and 4.2 cm were improved to 1.0 and 1.3 cm at postoperative measurements, respectively. A mean of 6.1 (range, 5-9) vertebral segments were osteotomized. We experienced no major complications.Conclusions: We found that a posterior-only procedure in patients with severe and rigid adolescent idiopathic scoliosis could provide correction rate, coronal and sagittal balance, and clinical outcomes comparable with other procedures. Using this technique can eliminate the need for the anterior release, with the associated complications related to anterior surgery, in the treatment of severe rigid scoliosis.

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“…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].…”

Section: Surgical Managementmentioning

confidence: 99%

Current concepts in the diagnosis and management of adolescent idiopathic scoliosis

2020

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Background Adolescent Idiopathic Scoliosis (AIS) is a complex 3D structural disorder of the spine that has a significant impact on a person's physical and emotionalstatus. Thus, efforts have been made to identify the cause of the curvature and improve management outcomes. Aim This comprehensive review looks at the relevant literature surrounding the possible aetio-pathogenesis of AIS, its clinical features, investigations, surgicalmanagement options, and reported surgical outcomes in anterior spinal fusion, posterior spinal fusion or combined approach in the treatment of AIS.

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Comparison of combined anterior–posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis

Cited by 49 publications

References 30 publications

Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample

Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample

Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report

Current concepts in the diagnosis and management of adolescent idiopathic scoliosis

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