Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Spine (Phila Pa 1976). 2023 Jul 15;48(14):E223-E234. doi: 10.1097/BRS.0000000000004529. Epub 2022 Nov 1.
Systematic review and meta-analysis.
This study aimed to compare the radiographical and clinical outcomes between anterior spinal fusion (ASF) and posterior spinal fusion (PSF) in Lenke type 5 adolescence idiopathic scoliosis.
PSF has been the standard operation for adolescence idiopathic scoliosis. ASF can also achieve a good curve correction effect with fewer fusion segments and minor invasion of paraspinal structures.
A systematic literature research was conducted in PubMed, Embase, Cochrane Library, and Web of Science. Use meta-analysis to compare the changes of thoracolumbar/lumbar and thoracic curves and other important outcomes between ASF and PSF.
A total of 427 ASF and 392 PSF patients from 12 studies were included. There was no significant difference in the correction degree of thoracolumbar/lumbar and thoracic curve between ASF and PSF ( P >0.05), except for PSF had more compensatory correction degree of thoracic curve at postoperation ( P <0.05). Besides, the loss of correction in thoracic curve in PSF at the last follow-up was significantly less than that in ASF ( P <0.05). PSF presented larger change values of thoracic kyphosis and lumbar lordosis at the last follow-up ( P <0.05). PSF showed a better effect in correcting trunk shift distance at the postoperation ( P <0.05) but less trunk shift distance correction from postoperation to last follow-up ( P <0.05). There was no significant difference in the incidence of proximal junctional kyphosis and estimated blood loss between the two approaches ( P >0.05). Moreover, ASF showed fewer fusion segments, but longer operation and hospital stay time ( P <0.05).
ASF is capable of achieving similar correction in coronal curve and balance as PSF with fewer fusion segments. Spine surgeons should select an appropriate approach tailored to individual patients needs while considering procedural risks and benefits.
Level II.
系统回顾和荟萃分析。
本研究旨在比较 Lenke 型 5 型青少年特发性脊柱侧凸的前路脊柱融合术（ASF）和后路脊柱融合术（PSF）的影像学和临床结果。
PSF 一直是青少年特发性脊柱侧凸的标准手术方法。ASF 也可以通过较少的融合节段和对脊柱旁结构的较小侵犯来实现良好的曲线矫正效果。
在 PubMed、Embase、Cochrane 图书馆和 Web of Science 中进行了系统的文献检索。使用荟萃分析比较 ASF 和 PSF 之间胸腰椎/腰椎和胸曲的变化以及其他重要结果。
共纳入 12 项研究的 427 例 ASF 和 392 例 PSF 患者。ASF 和 PSF 之间胸腰椎/腰椎和胸曲的矫正程度没有显著差异（P>0.05），除了 PSF 在术后有更多的胸曲代偿矫正程度（P<0.05）。此外，PSF 在末次随访时胸曲的矫正丢失明显少于 ASF（P<0.05）。PSF 在末次随访时的胸椎后凸和腰椎前凸变化值较大（P<0.05）。PSF 在术后即刻纠正躯干移位距离的效果较好（P<0.05），但从术后到末次随访时的躯干移位距离矫正较少（P<0.05）。两种方法的近端交界性后凸发生率和估计失血量无显著差异（P>0.05）。此外，ASF 具有较少的融合节段，但手术和住院时间较长（P<0.05）。
ASF 能够以较少的融合节段实现与 PSF 相似的冠状曲线和平衡矫正。脊柱外科医生应根据患者的个体需求选择合适的方法，同时考虑手术风险和获益。
II 级。
