Abstract
Study Purpose
A systematic review of the current literature to address the debate of the optimal surgical approach for the treatment of adolescent idiopathic scoliosis (AIS).
Method
All studies comparing anterior open instrumented surgery with posterior instrumented surgery in patients with AIS, written in English and published up until February 2010 were included. Electronic databases searched included Medline, PubMed and the Cochrane database using “AIS” and “surgery” as key words. Outcome measures considered to be important were specifically identified in each paper included: Blood loss (ml); operation time (mins); hospital stay (days); curve correction (sagittal and coronal); number of fused levels; pulmonary function, and complications.
Results
Twenty one relevant papers were identified from a possible 399. Nine of these studies were performed prospectively with four involving more than one centre. The average total number of patients in each study was 246 with a mean pre-operative curve Cobb angle of 47 degrees in those patients treated via anterior surgical instrumentation and 52 degrees with posterior surgery.
Three papers showed significant reduction in blood loss with anterior surgery while four studies observed a reduction in operative time and length of hospital stay with posterior surgery. Eleven papers analysed curve correction specifically and while comparable correction was achievable with both approaches the number of fusion levels was significantly fewer with anterior fixation in all. Three of the four studies evaluating lung function demonstrated that patients undergoing posterior fusion had better measures of pulmonary function than the anterior group. No significant difference was observed between the two approaches with regards to complications.
Conclusion
Both surgical approaches have their merits and disadvantages. Our study has not demonstrated one approach to be overall superior. Approach selection should be based on the advantages offered by each approach to the individual patient and the surgeon's own experience in spinal deformity correction.
