Can posterior-only surgery provide similar radiographic and clinical results as combined anterior (thoracotomy/thoracoabdominal)/posterior approaches for adult scoliosis?

STUDY DESIGN: Retrospective matched cohort analysis. OBJECTIVE: To determine if posterior-only (post-only) surgical techniques consisting of pedicle screws, osteotomies, transforaminal lumbar interbody fusion, and bone morphogenetic protein-2 may provide similar results as compared anterior (thoracotomy/thoracoabdominal)/posterior surgical approaches for the treatment of adult spinal deformity with respect to correction, fusion rates, or outcomes. SUMMARY OF BACKGROUND DATA: Combined anterior/posterior (A/P) fusion has traditionally been used to treat many adult scoliosis deformities. Anterior approaches negatively impact pulmonary function and require additional operative time and anesthesia. METHODS: Twenty-four patients who had A/P fusion for primary adult scoliosis (16 staged, 8 same-day) were matched with a cohort of 24 patients who had post-only treatment. Anterior fusion was performed via a thoracotomy (n = 1)/thoracoabdominal (n = 23) approach. All post-only surgeries were under one anesthesia. Minimum 2-year follow-up included radiographic, clinical, and outcomes data. RESULTS: There were no significant differences between groups for age, gender, diagnosis, comorbidities, preoperative curve magnitudes, or global balance. Postoperative radiographic correction and alignment were similar for both groups except for thoracolumbar curve percent improvement which was statistically better in the post-only group (P = 0.03). The average surgical time was higher in A/P versus post-only group (11.6 vs. 6.9 hours, P < 0.0001) as was total estimated blood loss (1330 vs. 980 mL, P = 0.04). Hospital length of stay (LOS) was longer in A/P versus post-only group (11.9 vs. 8.3 days, P = 0.03). There were no significant differences between postoperative complications. Revision surgery was performed in 5 A/P and 2 post-only patients. Higher pseudarthrosis rates found in the A/P versus post-only (17 vs. 0%) were not significant (P = 0.11). SRS-30 and Oswestry scores reflected a similar patient assessment before surgery, and improvement between groups at follow-up. CONCLUSION: Post-only adult scoliosis surgery achieved similar correction to A/P surgery while decreasing blood loss, operative time, length of stay, and avoiding additional anesthesia. Complications, radiographic, and clinical outcomes were similar at over 2-year follow-up Keywords : Adolescent,Adult,adverse effects,Aged,analysis,Anesthesia,blood,Blood Loss,Surgical,Bone Morphogenetic Protein 2,Bone Screws,Cohort Studies,Comorbidity,complications,diagnosis,diagnostic imaging,etiology,Female,Humans,instrumentation,Length of Stay,Male,methods,Middle Aged,Osteotomy,Patient Satisfaction,Patients,Postoperative Complications,Pseudarthrosis,Radiography,Reoperation,Retrospective Studies,Scoliosis,Spinal Fusion,Spine,surgery,Surveys and Questionnaires,Thoracotomy,Time,Treatment Outcome,Universities,Venous Thrombosis,Washington,, Posterioronly,Surgery,Provide,Similar,Radiographic, gluteus minimus spasm

Date of Publication : 2010 Jan 15

Authors : Good CR;Lenke LG;Bridwell KH;O’Leary PT;Pichelmann MA;Keeler KA;Baldus CR;Koester LA;

Organisation : Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/20038868

The London Spine Unit : Harley Street UK. Specialists in Cutting Edge Technologies for Spinal Surgery

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