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

Takashi Hirase, Jeremiah F. Ling, Varan Haghshenas, Jeyvikram Thirumavalavan, David Dong, Darrell S. Hanson, Rex A.W. Marco

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)267-281
Number of pages15
JournalSpine Deformity
Volume10
Issue number2
DOIs
StatePublished - Mar 2022

Keywords

  • Adolescent idiopathic scoliosis
  • Anterior fusion
  • Lenke 5
  • Posterior fusion

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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