Surgical Treatment of Scoliosis Lenke type 5, Anterior versus Posterior, which Approach is Better? A Systematic Review and Meta-analysis

Abstract

Study Design. Systematic review and meta-analysis.Objective. This study aimed to compare the radiographical and clinical outcomes between anterior spinal fusion (ASF) and posterior spinal fusion (PSF) in Lenke type 5 adolescence idiopathic scoliosis. Summary of Background Data. PSF has been the standard operation for adolescence idiopathic scoliosis. ASF can also achieve a good curve correction effect with fewer fusion segments and minor invasion of paraspinal structures. Materials and Methods. A systematic literature research was conducted in PubMed, Embase, Cochrane Library, and Web of Science. Use meta-analysis to compare the changes of thoracolumbar/ lumbar and thoracic curves and other important outcomes between ASF and PSF. Results. A total of 427 ASF and 392 PSF patients from 12 studies were included. There was no significant difference in the correction degree of thoracolumbar/lumbar and thoracic curve between ASF and PSF (P > 0.05), except for PSF had more compensatory correction degree of thoracic curve at postoperation (P < 0.05). Besides, the loss of correction in thoracic curve in PSF at the last follow-up was significantly less than that in ASF (P < 0.05). PSF presented larger change values of thoracic kyphosis and lumbar lordosis at the last follow-up (P < 0.05). PSF showed a better effect in correcting trunk shift distance at the postoperation (P < 0.05) but less trunk shift distance correction from postoperation to last follow-up (P < 0.05). There was no significant difference in the incidence of proximal junctional kyphosis and estimated blood loss between the two approaches (P > 0.05). Moreover, ASF showed fewer fusion segments, but longer operation and hospital stay time (P < 0.05). Conclusion. ASF is capable of achieving similar correction in coronal curve and balance as PSF with fewer fusion segments. Spine surgeons should select an appropriate approach tailored to individual patients needs while considering procedural risks and benefits.

Spine

“…In this meta-analysis from Beijing (China) , the clinical and radiological outcomes of each strategy are analyzed in an attempt to establish which option currently appears to give superior results. 3 Overall, 12 studies met the inclusion criteria following an extensive and well-constructed systematic search. These studies reported a cohort of 819 patients, comprising of 427 patients treated through an anterior spinal fusion (ASF) and 392 treated through a posterior spinal fusion (PSF).…”

Development of Notch-Free, Pre-Bent Rod Applicable for Posterior Corrective Surgery of Thoracolumbar/Lumbar Adolescent Idiopathic Scoliosis

“…Patients with Lenke types 1-4 and type 6 AIS curves were also excluded. The average age and body height at operation were 14.7 ± 1.9 years (range, [12][13][14][15][16][17][18] and 157.7 ± 6.6 cm (range, 149-173), respectively.…”

“…Although the anterior approach remains useful for Lenke type 5 AIS, posterior spinal fusion with pedicle screw instrumentation is currently the standard technique, with a relatively low complication rate [8][9][10]. Some authors have demonstrated that the posterior approach has no significant difference in the coronal and sagittal correction compared to the anterior approach, although the anterior approach has the advantage of saving fusion levels [11][12][13][14][15].…”