title: Spring-assisted surgery in the treatment of sagittal synostosis: A systematic review.
abstract: BACKGROUND
  Premature sagittal synostosis (SS) can be surgically corrected using extensive cranioplasties or using less invasive methods, e.g. spring-assisted surgery (SAS).
  
  
  OBJECTIVE
  The aim of the present study was to perform a proper systematic review of springs in the treatment of SS.
  
  
  METHODS
  A literature search was performed with the assistance of a professional librarian in the databases PubMed, EMBASE, and The Cochrane Library between 1997 and September 2013. Studies that fulfilled the PICO (patients, interventions, controls, outcome) criteria were included. All studies were graded for methodological quality according to MINORS, and all retrospective studies were assessed according to a scale developed for retrospective studies in paediatric surgery. The quality of evidence was rated according to GRADE.
  
  
  RESULTS
  A total of 241 abstracts were extracted in the literature search. Five studies met the PICO criteria. Two of these five were considered as preliminary reports and excluded. Assessment according to MINORS showed a mean score of 21, i.e. fair quality. The clinical outcome regarding cephalic index did not differ between the surgical techniques, but the quality of evidence, according to GRADE, that SAS was equally efficient, was very low. Clinical outcome regarding operation time, blood loss, ICU stay and hospital stay was in favour for SAS, but the quality of evidence was low.
  
  
  CONCLUSIONS
  This systematic review has revealed that the level of evidence for SAS being an equally efficient surgical method as more extensive cranioplasties for SS is low or very low. The results point out the need for well-designed prospective studies within craniofacial surgery.
authors: Department of Plastic Surgery, Institute for Clinical Sciences, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden.
authors: Giovanni
authors: G
authors: Maltese
authors: Sara
authors: S
authors: Fischer
authors: Annika
authors: A
authors: Strandell
authors: Peter
authors: P
authors: Tarnow
authors: Lars
authors: L
authors: Kölby
mesh_terms: D003398:Craniosynostoses / Q000601:surgery*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000295:instrumentation*
keywords: Sagittal synostosis; pi-plasty; spring-assisted surgery; systematic review