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Implant density in adolescent idiopathic scoliosis: a meta-analysis of clinical and radiological outcomes

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Abstract

Background

Adolescent idiopathic scoliosis (AIS) affects 1–3% of adolescents, and treatment approaches, including the density of constructs in surgical fusion, vary among orthopedic surgeons. Studies have sought to establish whether high-density or low-density constructs offer superior clinical and radiological outcomes, yet conclusive results are lacking. This meta-analysis aims to provide a definitive answer to the controversial and ambiguous question surrounding the efficacy of different pedicle screw densities in treating AIS.

Methods

PubMed, Cochrane, and Google Scholar (page 1–20) were searched till December 2023. The studied outcomes were Major Cobb angle, major curve correction, lumbar curve, kyphosis (T5–T12), lumbar lordosis, coronal balance, LIV Tilt angle, TAV translation, LAV translation, apical trunk rotation, trunk shift, SRS-22, operative time, blood loss, complications and cost.

Results

Twenty-four studies (total of 1985 patients, 1045 in LD group and 940 in HD group) were included in this meta-analysis. A statistically significant better improvement in ATR (p = 0.02) and LIV tilt angle (p = 0.02) was seen in the high-density group. On the other hand, longer operative time (p = 0.002), blood loss (p = 0.0004) and costs (p = 0.02) were seen in the high-density group. No difference was seen in the remaining radiographic and clinical outcomes between both surgeries.

Conclusion

Both low-density (LD) and high-density (HD) screw constructs show comparable and satisfactory radiographic and QOL for AIS patients. Furthermore, HD constructs had increased costs, operative time, and blood loss associated. However, a definitive conclusion cannot be made and more studies taking into account multiple additional variables are necessary to do so.

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Authors and Affiliations

  1. School of Medicine, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon

    Marven Aoun, Mohammad Daher, Gaby Kreichati & Amer Sebaaly

  2. Department of Orthopedic Surgery, Brown University, Providence, RI, 02906, USA

    Mohammad Daher

  3. Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon

    Aren-Joe Bizdikian, Gaby Kreichati, Khalil Kharrat & Amer Sebaaly

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  1. Marven Aoun
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Contributions

MA: Data acquisition, Writing original draft, Approved the version to be submitted, Accountable for all aspects of the work. MD: Data acquisition, Writing original draft, Approved the version to be submitted, Accountable for all aspects of the work. AB: Data acquisition, Writing original draft, Approved the version to be submitted, Accountable for all aspects of the work. GK: Interpretation of data, Review, editing, Approved the version to be submitted, Accountable for all aspects of the work. KK: Interpretation of data, Review, editing, Approved the version to be submitted, Accountable for all aspects of the work. AS: Interpretation of data, Review, editing, and supervision, Approved the version to be submitted, Accountable for all aspects of the work.

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Correspondence to Amer Sebaaly.

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AS is consultant for Medtronic (with no relation to this work). All other authors report no conflict of interest.

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Aoun, M., Daher, M., Bizdikian, AJ. et al. Implant density in adolescent idiopathic scoliosis: a meta-analysis of clinical and radiological outcomes. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00860-9

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