Hirase Takashi, Ling Jeremiah F, Haghshenas Varan, Thirumavalavan Jeyvikram, Dong David, Hanson Darrell S, Marco Rex A W
Houston Methodist Orthopedics and Sports Medicine, 6445 Main Street, Suite 2500, Houston, TX, 77030, USA.
Texas A&M University Health Science Center College of Medicine, 8447 Riverside Pkwy, Bryan, TX, 77807, USA.
Spine Deform. 2022 Mar;10(2):267-281. doi: 10.1007/s43390-021-00436-x. Epub 2021 Nov 1.
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).
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.
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.
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.
回顾并比较前路脊柱融合术（ASF）和后路脊柱融合术（PSF）治疗Lenke 5型青少年特发性脊柱侧凸（AIS）的临床和影像学结果。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价。纳入所有研究ASF和PSF治疗Lenke 5型AIS的临床和影像学结果的I-III级证据研究。
纳入9项研究（285例ASF患者，298例PSF患者）。与PSF相比，ASF融合节段数量显著更少（p < 0.01），即刻和长期冠状面畸形矫正效果相似（分别为p = 0.16；p = 0.12）。在一项研究中，PSF对胸椎后凸不足的矫正效果更好，在三项研究中，PSF对腰椎前凸不足的矫正效果更好。与ASF相比，PSF的住院时间（LOS）显著更短（p < 0.01）。一项长期研究表明，与ASF相比，PSF的近端交界性后凸（PJK）发生率显著更高。主要并发症或再次手术率无显著差异。
对于Lenke 5型AIS的治疗，有中等证据表明，与PSF相比，ASF实现相似的即刻和长期冠状面畸形矫正所需的内固定节段数量更少。有一些证据表明，与ASF相比，PSF可能对胸腰椎矢状面畸形矫正效果更好。有一些证据表明，与ASF相比，PSF长期随访时PJK的发生率更高。与PSF相比，ASF术后LOS更长。
