Comparison of combined anterior-posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis

Purpose: Choosing a surgical approach to treat adolescent idiopathic scoliosis (AIS) is still controversial. To compare the effectiveness and safety of combined anterior-posterior approach to posterior-only approach, we conducted a meta-analysis.

Methods: We searched electronic database for relevant studies that compared anterior-posterior approach with posterior approach in AIS. Then data extraction and quality assessment were conducted. We used RevMan 5.1 for data analysis. A random effects model was used for heterogeneous data, while a fixed effect model was used for homogeneous data.

Results: A total of ten non-randomized controlled studies involving 872 patients were included. There was no significant difference in Cobb angle (95 % CI -0.33 to 4.91, P = 0.09) and percent-predicted FEV1 (95 % CI -6.79 to 4.54, P = 0.70) between the two groups. In subgroup analysis, the kyphosis angle correction was significantly higher than posterior group in severe subgroup (95 % CI 0.72-6.50, P = 0.01), while no significant difference was found in no-restriction subgroup (95 % CI -2.75 to 5.42, P = 0.52). Patients in posterior group obtained a better percent-predicted FVC than those in anterior-posterior group (95 % CI -13.18 to -4.74, P < 0.0001). Significant less complication rate (95 % CI 2.75-17.49, P < 0.0001), blood loss (95 % CI 363.28-658.91, P < 0.00001), operative time (95 % CI 2.65-3.45, P < 0.00001) and length of hospital stay (95 % CI 1.98-22.94, P = 0.02) were found in posterior group.

Conclusions: Posterior-only approach can achieve similar coronal plane correction and percent-predicted FEV1 compared to combined anterior-posterior approach. The posterior approach even does better in sagittal correction in severe AIS patients. Significantly less complication rate, blood loss, operative time, length of hospital stay and better percent-predicted FVC are also achieved by posterior-only approach. Posterior-only approach seems to be effective and safe in treating AIS for experienced surgeons.