Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2020 May 1;45(9):612-620.
doi: 10.1097/BRS.0000000000003331.

A 10-Year Radiographic Study Comparing Anterior Versus Posterior Instrumented Spinal Fusion in Patients With Lenke Type 5 Adolescent Idiopathic Scoliosis

Joel Louis Lim  1 , Hwee Weng Dennis Hey  1 , Nishant Kumar  1 , Alex Quok An Teo  1 , Leok Lim Lau, Hwan Tak Hee  2 , John Nathaniel Ruiz  1 , Naresh Satyanarayan Kumar  1 , Joseph Shanthakumar Thambiah  1 , Gabriel Ka-Po Liu  1 , Hee-Kit Wong  1
Affiliations
Comparative Study

A 10-Year Radiographic Study Comparing Anterior Versus Posterior Instrumented Spinal Fusion in Patients With Lenke Type 5 Adolescent Idiopathic Scoliosis

Joel Louis Lim et al. Spine (Phila Pa 1976). .

Abstract

MINI: This is a long-term prospective cohort study comparing the radiographic outcomes of anterior versus posterior instrumentation for Lenke 5 adolescent idiopathic scoliosis. Both approaches were comparable in terms of radiographic outcomes up to 10 years. The posterior approach is more prone to developing proximal junctional kyphosis.

Study design: Prospective cohort study.

Objective: To compare the long-term, radiographic coronal and sagittal outcomes of these two approaches at 10-year follow-up.

Summary of background data: Both anterior and posterior instrumented fusions have been found to be safe and effective treatments for Lenke 5 adolescent idiopathic scoliosis with up to 2 to 5 years of follow-up. Few studies follow patients beyond this duration.

Methods: 36 patients who underwent anterior (n = 25) or posterior instrumented spinal fusion (n = 11) for Lenke 5 adolescent idiopathic scoliosis over a 4-year period were recruited and followed for 10 years. Preoperative clinical data include patient's age and age of menarche. Operative data included instrumented levels, duration of surgery, and surgical blood loss. Postoperative data included duration of hospital stay, duration of intensive care unit stay, and complications. Pre- and postoperative radiographic data collected include coronal Cobb angles for structural thoracolumbar/lumbar curves, and sagittal angles-sagittal vertical axis, thoracic kyphosis, global lumbar angle, pelvic incidence, pelvic tilt, sacral slope, and upper and lower end vertebrae.

Results: Posterior surgery had a shorter operative time (P < 0.010) and hospital stay (P < 0.010). Coronal plane deformity improved by a mean of 74% in the anterior group and 71% in the posterior group. There was no significant change at 10 years in both groups (anterior P = 0.455 and posterior P = 0.325). Sagittal parameters remained unchanged. There was a higher incidence of proximal junctional kyphosis in the posterior (45%) compared to the anterior (16%) group (P < 0.010).

Conclusion: Both anterior and posterior instrumentation and fusion are successful surgeries after 10 years of follow-up. They are comparable with regards to their ability to achieve and maintain good correction of scoliotic deformities and have a low rate of pseudoarthrosis and instrument failure. Ideal sagittal parameters are maintained up to 10 years of follow-up.

Level of evidence: 3.

Plain language summary

Prospective cohort study. To compare the long-term, radiographic coronal and sagittal outcomes of these two approaches at 10-year follow-up. Both anterior and posterior instrumented fusions have been found to be safe and effective treatments for Lenke 5 adolescent idiopathic scoliosis with up to 2 to 5 years of follow-up. Few studies follow patients beyond this duration. 36 patients who underwent anterior (n = 25) or posterior instrumented spinal fusion (n = 11) for Lenke 5 adolescent idiopathic scoliosis over a 4-year period were recruited and followed for 10 years. Preoperative clinical data include patient's age and age of menarche. Operative data included instrumented levels, duration of surgery, and surgical blood loss. Postoperative data included duration of hospital stay, duration of intensive care unit stay, and complications. Pre- and postoperative radiographic data collected include coronal Cobb angles for structural thoracolumbar/lumbar curves, and sagittal angles—sagittal vertical axis, thoracic kyphosis, global lumbar angle, pelvic incidence, pelvic tilt, sacral slope, and upper and lower end vertebrae. Posterior surgery had a shorter operative time (P < 0.010) and hospital stay (P < 0.010). Coronal plane deformity improved by a mean of 74% in the anterior group and 71% in the posterior group. There was no significant change at 10 years in both groups (anterior P = 0.455 and posterior P = 0.325). Sagittal parameters remained unchanged. There was a higher incidence of proximal junctional kyphosis in the posterior (45%) compared to the anterior (16%) group (P < 0.010). Both anterior and posterior instrumentation and fusion are successful surgeries after 10 years of follow-up. They are comparable with regards to their ability to achieve and maintain good correction of scoliotic deformities and have a low rate of pseudoarthrosis and instrument failure. Ideal sagittal parameters are maintained up to 10 years of follow-up. Level of Evidence: 3.

PubMed Disclaimer

References

    1. King HA, Moe JH, Bradford DS, Winter RB. The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am 1983; 65:1302–1313.
    1. Kadoury S, Labelle H. Classification of three-dimensional thoracic deformities in adolescent idiopathic scoliosis from a multivariate analysis. Eur Spine J 2012; 21:40–49.
    1. Lenke LG, Betz RR, Harms J, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 2001; 83-A:1169–1181.
    1. Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 2012; 37:1077–1082.
    1. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005; 30:2024–2029.

Publication types

MeSH terms