title: One-step (standard) versus two-step surgical approach in adolescent idiopathic scoliosis posterior spinal fusion: Which is better?
abstract: METHODS
  A retrospective cohort study with IRB approval.
  
  
  BACKGROUND
  Significant blood loss remains an important concern in terms of the performance of the posterior spinal fusion in adolescent idiopathic scoliosis. Several strategies have been reported to minimize blood loss during surgery. In order to address the need to minimize blood loss without sacrificing the quality of the fusion, in our hospital, we adopted a two-step surgical approach. This surgical approach consist of the exposure and instrumentation of the lumbar region prior to and followed by an extension of the surgical incision to the thoracic region for its subsequent instrumentation. The main purpose of this study was to compare a two-step surgical approach with the one-step (standard) approach.
  
  
  METHODS
  This study was a review of all the data on consecutive posterior spinal fusion surgeries performed by a specific two-surgeon team during 2004-2013. Demographics, surgical variables, radiographic findings, and outcomes regarding blood loss, morbidity, and the duration of the procedure were evaluated.
  
  
  RESULTS
  Eighty-five patients underwent the standard surgical exposure, and 41 patients underwent the two-step surgical technique. With the exception of BMI, neither group showed any statistically preoperative variable significant differences. None of the postoperative outcome variables were statistically significant between both surgical approaches.
  
  
  CONCLUSIONS
  No differences were detected in terms of using a two-step surgical approach versus the one-step standard surgical approach regarding perioperative blood loss, surgical time, or complications.
  
  
  METHODS
  Level of evidence III.
authors.affiliation: Pediatric Orthopedic Department, Hospital de la Concepción, Box 6847 Marina Station, Mayagüez, 00681, Puerto Rico. normanpipe@aol.com.
authors.forename: Norman
authors.initials: N
authors.lastname: Ramirez
authors.affiliation: Biology Department, Inter-American University, San German, San German, Puerto Rico.
authors.forename: Pablo
authors.initials: P
authors.lastname: Valentin
authors.affiliation: School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico.
authors.forename: Manuel
authors.initials: M
authors.lastname: García-Cartagena
authors.affiliation: Biology Department, University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico.
authors.forename: Solais
authors.initials: S
authors.lastname: Samalot
authors.affiliation: Public Health Program, and Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico.
authors.forename: Ivan
authors.initials: I
authors.lastname: Iriarte
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D002648:Child; D015331:Cohort Studies; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D011859:Radiography / Q000379:methods; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome
keywords: Adolescent idiopathic scoliosis; Blood loss; Scoliosis; Surgical management