New Study Delivers Surprise Outcome of Posterior vs Anterior Scoliosis Test
Posterior or anterior approach for Lenke 5C curves? Easy answer, right? Not so fast. A new study–titled “A Detailed Comparative Analysis of Anterior Versus Posterior Approach to Lenke 5C Curves”—is appearing in the March 1, 2018 edition of Spine that delivers some surprising new insights into this simple question—but complex issue.
The authors wrote, “Historically, ASIF [anterior spinal instrumented fusion] has been the treatment of choice for treatment of thoracolumbar adolescent idiopathic scoliosis. More recently, PSIF [posterior spinal instrumented fusion] has gained popularity for its ease, versatility, and amount of correction achieved. Current literature lacks a prospective comparative analysis between these two approaches to better aid treating surgeons in decision making when treating Lenke 5C curves.”
Firoz Miyanji, M.D., clinical associate professor in the Department of Orthopedics at the British Columbia Children’s Hospital in Vancouver, British Columbia, Canada, and co-author on the study, told OTW, “Clinically, we were seeing some curves (thoracolumbar, Lenke 5s) that although treated posteriorly with pedicle screw constructs and Ponte releases still had some degree of trunk shift that questioned whether or not they should have had a longer fusion by at least 1 (or more) levels.”
The authors wrote, “A prospective, longitudinal multicenter adolescent idiopathic scoliosis database was used to identify 161 consecutive patients with Lenke 5C curves treated by ASIF with a dual rod system, or PSIF with a pedicle screw-rod construct. Pre- and 2-year postoperative radiographic data, Scoliosis Research Society outcome scores, and perioperative comparisons were made between the two approaches…A total of 69 patients were treated with ASIF and 92 patients with PSIF.”
“Yes, the study is an international, multicenter study for which the data, although analyzed in a retrospective manner, was prospectively collected over many years. This adds validity to the findings and allow the results to be more generalizable than simply originating from one, single center.”
“The most important results were that these particular curves (i.e., thoracolumbar curves, Lenke 5) if treated from an anterior approach, continue to result in shorter fusions compared to being treated from a posterior approach. However, the sagittal profile (restoring lumbar lordosis) and rotational correction (lumbar prominence) were better in those patients that had a posterior approach.”
“When choosing fusion levels in these curves (Lenke 5), one cannot apply the same ‘rules’ as an anterior approach if treating these curves posteriorly. The surgeon may need to go longer distally if treating these curves from a posterior approach—not always, but in some, select cases. Other items need to be considered in the decision making process of fusion level selection, particularly the lowest instrumented vertebra.”
“There still remains a role for anterior surgery in patients with Lenke 5 curves and the decision to treat these from either an anterior or posterior approach should be made individually for that particular patient.”
