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


BACKGROUND
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.


CONCLUSIONS
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.
Good
Christopher R
CR
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Lenke
Lawrence G
LG
Bridwell
Keith H
KH
O'Leary
Patrick T
PT
Pichelmann
Mark A
MA
Keeler
Kathryn A
KA
Baldus
Christine R
CR
Koester
Linda A
LA
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology