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Anterior versus posterior spinal fusion for Lenke type 5 adolescent idiopathic scoliosis: a systematic review and meta-analysis of comparative studies

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A Correction to this article was published on 29 November 2021

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Abstract

Purpose

To review and compare clinical and radiologic outcomes between anterior spinal fusion (ASF) and posterior spinal fusion (PSF) for the treatment of Lenke type 5 adolescent idiopathic scoliosis (AIS).

Methods

A systematic review was performed according to Preferred reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. All level I–III evidence studies investigating the clinical and radiologic outcomes of ASF and PSF for the treatment of Lenke type 5 AIS were included.

Results

Nine studies (285 ASF patients, 298 PSF patients) were included. ASF was associated with a significantly lower number of levels fused compared with PSF (p < 0.01) with similar immediate and long-term coronal deformity correction (p = 0.16; p = 0.12, respectively). PSF achieved a better correction of thoracic hypokyphosis in one study and lumbar hypolordosis in three studies. PSF was associated with a significant shorter length of stay (LOS) compared with ASF (p < 0.01). One long-term study demonstrated a significantly higher rate of proximal junctional kyphosis (PJK) with PSF compared with ASF. There were no significant differences in major complication or re-operation rates.

Conclusion

For the treatment of Lenke type 5 AIS, there is moderate evidence to suggest that ASF requires a lower number of instrumented levels to achieve similar immediate and long-term coronal deformity correction compared with PSF. There is some evidence to suggest that PSF may achieve better thoracic and lumbar sagittal deformity correction compared with ASF. There is some evidence to suggest a higher incidence of PJK at long-term follow-up with PSF compared with ASF. ASF is associated with a longer post-operative LOS compared with PSF.

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Funding

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Authors and Affiliations

  1. Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX, 77030, USA

    Takashi Hirase, Varan Haghshenas, David Dong, Darrell S. Hanson & Rex A. W. Marco

  2. Texas A&M University Health Science Center College of Medicine, 8447 Riverside Pkwy, Bryan, TX, 77807, USA

    Takashi Hirase, Jeremiah F. Ling & Jeyvikram Thirumavalavan

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  1. Takashi Hirase
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Contributions

TH: Made substantial contributions to the conception and design of work, drafted the work, approved version to be published, and agreed to be accountable for all aspects of work. JFL: Made substantial contributions to the acquisition, analysis, and interpretation of the data, drafted the work, approved version to be published, and agreed to be accountable for all aspects of work. VH: Made substantial contributions to the acquisition, analysis, and interpretation of the data, drafted the work, approved version to be published, and agreed to be accountable for all aspects of work. JT: Made substantial contributions to the acquisition, analysis, and interpretation of the data, drafted the work, approved version to be published, and agreed to be accountable for all aspects of work. DD: Made substantial contributions to the acquisition, analysis, and interpretation of the data, drafted the work, approved version to be published, and agreed to be accountable for all aspects of work. DSH: Senior surgeon who made substantial contributions to the acquisition, analysis, and interpretation of the data, drafted the work, approved version to be published, and agreed to be accountable for all aspects of work. RAWM: Senior surgeon who made substantial contributions to the acquisition, analysis, and interpretation of the data, drafted the work, approved version to be published, and agreed to be accountable for all aspects of work.

Corresponding author

Correspondence to Takashi Hirase.

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Conflict of interest

Takashi Hirase, Jeremiah Ling, Varan Haghshenas, Richard Fuld III, David Dong, and B Christoph Meyer declare no potential conflicts of interest with respect to research, authorship, and/or publication of this article. Rex AW Marco has the following disclosures: DePuy, A Johnson & Johnson Company: Paid presenter or speaker; Globus Medical: Paid presenter or speaker; Musculoskeletal Tumor Society: Board or committee member; Stryker: Paid presenter or speaker; Synaptive Medical: Paid presenter or speaker. Darrell S Hanson has the following disclosures: DePuy, A Johnson & Johnson Company: IP royalties; Paid consultant; Paid presenter or speaker; Medtronic Sofamor Danek: Paid consultant; Paid presenter or speaker.

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Hirase, T., Ling, J.F., Haghshenas, V. et al. Anterior versus posterior spinal fusion for Lenke type 5 adolescent idiopathic scoliosis: a systematic review and meta-analysis of comparative studies. Spine Deform 10, 267–281 (2022). https://doi.org/10.1007/s43390-021-00436-x

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