Introduction
Aetio-pathogenesis
Genetics
Oestrogens
Calmodulin
Melatonin
Abnormal skeletal growth and biomechanical theories
Low bone mineral density (osteopenia)
Vitamin D
Clinical features
Investigations
Sequelae
Non-surgical management
Surgical management
Study | Level of evidence | Follow-up time | Approach | Number of patients | Results | Conclusion |
---|---|---|---|---|---|---|
Patel et al. [57] | III | Min. 2 years | Anterior | 132 | • No statistical difference between anterior (48%) and posterior (49%) approaches in SLCC. | Equal SLCC can be reliably achieved with either surgical approach. |
Posterior | 44 | |||||
Nohara et al. [58] | III | Min. 10 years | Anterior | 30 | • In PSF, AO occurred in 47%, progression of scoliosis in 7% and disc degeneration in 43%. • In ASF, AO occurred in 53%, progression of scoliosis in 37% and disc degeneration in 53%. | Scoliosis correction was better with ASF immediately postoperatively; however, greater loss of correction occurred at 10 years post op. |
Posterior | 30 | |||||
Sucato et al. [59] | III | Post op, 1 year and 2 years | Anterior | 135 | • After surgery, T5–T12 kyphosis was significantly greater after ASF and remained greater at 1 and 2 years post op. | ASF is the best method to restore thoracic kyphosis when compared with PSF. |
Posterior | 218 | |||||
Tao et al. [60] | III | Post op, 1 year and 2 years | Anterior | 21 | • Average of 0.61 less segments fused in ASF compared with 0.81 in PSF • SRS-22 scores for pain, self-image/appearance, function/activity, mental and satisfaction of management were significantly higher in ASF group. | ASF results in shorter fusion segments, better sagittal alignment, and QOL than PSF in patients with Lenke type 5 AIS. |
Posterior | 26 | |||||
Abel et al. [61] | III | 2 years | Anterior | 40 | • PSF had significantly more fused levels than ASF. • ASF had greater percent of lumbar Cobb correction when dLOF was standardised to L3. | Surgeons treating Lenke 5C curves with PSF include more segments. When controlled for the distal level of fixation, ASF provides superior correction of the thoracolumbar curve. |
Posterior | 40 | |||||
Li et al. [62] | III | Min. 2 years | Anterior | 22 | • Percent correction of lumbar curve and spontaneous correction of un-fused thoracic curve was similar in both groups. • Fusion levels were significantly shorter in ASF. | There was no statistically significant difference between the 2 approaches in lumbar correction or thoracic correction, but fusion levels were shorter in ASF group. |
Posterior | 24 | |||||
Miyanjii et al. [63] | II | Min. 2 years | Anterior | 69 | • No significant differences in percentage correction of the main curve, C7 decompensation, length of hospital stay and SRS outcome scores at 2-year follow-up. • ASF resulted in less levels fused. • PSF resulted in less disc angulation below lowest instrumented vertebrae, greater lumbar lordosis and greater percent correction of lumbar prominence. | The amount of correction achieved was comparable between ASF and PSF. ASF resulted in shorter fusions compared with PSF but there was increased disc angulation below the lowest instrumented vertebrae, less lumbar lordosis, and a lower % correction of the lumbar prominence than PSF. |
Posterior | 92 | |||||
Rushton et al. [64] | II | 2 years | Anterior | 18 | • No significant differences in the degree of improvement in any areas of the Modified Scoliosis Research Society Outcome Instrument between the groups. • PSF corrected rib hump by 53% and thoracic curve Cobb angle by 62%, whilst ASF corrected rib hump by 61% and thoracic curve Cobb angle by 64%. • The complications were varied and largely intrathoracic in ASF and wound-related in PSF. | Patients with right thoracic AIS of differing curve types but otherwise similar preoperatively demonstrated that ASF and PSF are largely equivalent. Differences in the effect of sagittal alignment, operative time and complications should be considered when selecting approach. |
Posterior | 24 | |||||
Sudo et al. [65] | III | Average 15.2 years | Anterior | 25 | • Overall radiographical findings and patient outcome measures were satisfactory. • Average preoperative instrumented level was significantly improved at follow-up; however, average percent-predicted FVC and FEV1 were significantly reduced. | Overall radiographical findings and patient outcome measures of ASF for Lenke 1 MT AIS were satisfactory at an average follow-up of 15 years. Percent-predicted values of FVC and FEV1 were decreased in this cohort, although no patient had complaints related to pulmonary function. |
Ghandari et al. [66] | IV | Average 5.6 years | Posterior | 42 | • Postoperative vertebral tilt below the site of fusion increased from 6.21° ± 5.73° to 11.12° ± 7.92°. • Mean postoperative Oswestry Disability Index (ODI) was 16.7 ± 9.8. • New DDD was observed in 16%. | Despite the efficacy and safety of PSF, it might result in irreversible complications such as DDD. Moreover, the amount of postoperative disability may increase over time. |
Luo et al. [67] | III | N/A | Anterior and Posterior approach | 308 | • No significant differences were noted in correction rate of thoracolumbar/lumbar curve and incidence of proximal junctional kyphosis, in change values of thoracolumbar/lumbar curve and thoracic kyphosis. • ASF had significantly shorter fusion segments. • PSF obtained a larger increasing Cobb angle of lumbar lordosis. | ASF and PSF can obtain similar coronal correction, change values of thoracic kyphosis, and incidence of proximal junctional kyphosis. ASF saves roughly one more fusion segment and PSF can obtain a larger increasing Cobb angle of lumbar lordosis. |
Chen et al. [68] | III | N/A | Combined and posterior approach | 872 | • No significant difference in Cobb angle and percent-predicted FEV1. • Patients in posterior group obtained a better percent-predicted FVC. • Significant less complications, blood loss, operative time and length of hospital stay in posterior group. | Posterior-only approach can achieve similar coronal plane correction and percent-predicted FEV1 compared with combined anterior-posterior approach. Significantly less complication rate, blood loss, operative time, length of hospital stay and better percent-predicted FVC are also achieved by posterior-only approach. |
Pourfeizi et al. [69] | III | N/A | Combined | 25 | • Patients treated through posterior-only and combined approaches were respectively hospitalised for 11.84 ± 5.18 and 26.5 ± 5.2 days • Significant difference between these two groups when considering intensive care unit admission duration, correction in sagittal view of X-ray and number of days the patients underwent traction. | The posterior-only method is associated with some significant advantages and is an advisable method in patients with severe scoliosis over than 70°. |
Posterior | 25 | |||||
Dobbs et al. [70] | III | Min 2 years | Combined | 20 | • No statistically significant differences between the number of levels fused, preoperative coronal/sagittal Cobb measurements, coronal curve flexibility or amount of postoperative coronal Cobb correction. • Less of a negative effect on pulmonary function in PSF. | A posterior-only approach has the advantage of providing the same correction as an anterior/posterior spinal fusion, without the need for entering the thorax and more negatively impacting pulmonary function. |
Posterior | 34 | |||||
Shi et al. [71] | II | 3 months, 6 months, 1 year, 2 years and 3 years | Combined | 25 | • No significant differences in operation time, blood loss, length of hospital stay, SRS-22 Score, coronal curve flexibility or postoperative coronal Cobb correction ratio between approaches. • Implant density was significantly lower in the combined group. • 12 screws were misplaced in the posterior group. | In patients with rigid thoracic AIS, PSF could attain the same curve correction as a combined approach by increasing the implant density. Nevertheless, for patients with a high risk of implant complications, the combined approach is still recommended. |
Posterior | 38 |