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Hybrid vs all pedicle screws constructs in adolescent idiopathic scoliosis: a metaanalysis of clinical and radiological outcomes

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Abstract

Background

Adolescent idiopathic scoliosis (AIS) affects around 1 to 3% of young individuals, leading to spinal deformities typically exceeding a Cobb angle of 10 degrees without congenital or neuromuscular causes. Advances in treatment now include various surgical techniques such as posterior fusion utilizing all-pedicle screw constructs or hybrid constructs.

Methods

PubMed, Cochrane, and Google Scholar (pages 1–20) were searched up until February 2024. Comparative studies in which the cohort was separated into two groups (HC and PSC) were included. Data consisting of, surgery-related outcomes, sagittal radiographic outcomes, coronal radiographic outcomes, and patient-reported outcomes, was extracted and compared.

Results

Twenty-eight studies including 3435 patients were included. Higher rates of complications (Odds-Ratio = 1.99, p < 0.00001) and reoperations (Odds-Ratio = 2.82, p < 0.00001) were seen in the hybrid group. Better radiographic coronal correction was seen in the PSC group in both the major curve (Mean Difference = 5.97, p < 0.00001) and the secondary curve (Mean Difference = − 10.73, p < 0.0001). However, restoration of sagittal alignment was better in the HC group when assessing thoracic kyphosis (Mean Difference = 2.97, p = 0.02) and lumbar lordosis (Mean Difference = 3.17, p = 0.005).

Conclusion

While all-pedicle screw constructs demonstrated greater stability in AIS compared to hybrid constructs, resulting in reduced rates of reoperations and complications, as well as improved correction of major and secondary curves, they were unable to fully restore optimal sagittal alignment.

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Authors and Affiliations

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

    Mohammad Daher

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

    Mohammad Daher, Marven Aoun, Gaby Kreichati & Amer Sebaaly

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

    Gaby Kreichati, Khalil Kharrat & Amer Sebaaly

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  1. Mohammad Daher
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  2. Marven Aoun
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  3. Gaby Kreichati
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  4. Khalil Kharrat
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Contributions

MD: Data acquisition, Writing original draft, Approved the version to be submitted, Accountable for all aspects of the work. MA: 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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Daher, M., Aoun, M., Kreichati, G. et al. Hybrid vs all pedicle screws constructs in adolescent idiopathic scoliosis: a metaanalysis of clinical and radiological outcomes. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00886-z

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