title: Anterior versus posterior approach in Lenke 5C adolescent idiopathic scoliosis: a meta-analysis of fusion segments and radiological outcomes.
abstract: BACKGROUND
  Radiological outcomes between anterior and posterior approach in Lenke 5C curves were still controversial. Meta-analysis on published articles to compare fusion segments and radiological outcomes between the two surgical approaches was performed.
  
  
  METHODS
  Electronic database was conducted for searching studies concerning the anterior versus posterior approach in Lenke 5C curves. After quality assessment, data of means, standard deviations, and sample sizes were extracted. RevMan 5.3 was adopted for data analysis.
  
  
  RESULTS
  Seven case-control studies involving 308 Lenke 5C AIS patients were identified in the meta-analysis. No significant differences were noted in correction rate of thoracolumbar/lumbar curve (95 % CI -6.02 to 4.32, P = 0.75) and incidence of proximal junctional kyphosis (95 % CI 0.12 to 7.19, P = 0.94) of final follow-up, in change values of thoracolumbar/lumbar curve (95 % CI -3.28 to 7.19, P = 0.46) and thoracic kyphosis (95 % CI -4.10 to 0.13, P = 0.07). The anterior approach represented a significant shorter fusion segments compared to posterior approach (95 % CI -1.72 to -0.71, P < 0.00001). The posterior approach obtained a larger increasing Cobb angle of lumbar lordosis than the anterior approach (95 % CI -6.06 to -0.61, P = 0.02).
  
  
  CONCLUSIONS
  The anterior and posterior approach can obtain comparable coronal correction, change values of thoracic kyphosis, and incidence of proximal junctional kyphosis. The anterior approach saves approximate one more fusion segment, and the posterior approach can obtain a larger increasing Cobb angle of lumbar lordosis, from preoperation to final follow-up.
  
  
  BACKGROUND
  The article type of this study is meta-analysis and prospective registration is not required.
authors.affiliation: Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, People's Republic of China.
authors.forename: Ming
authors.initials: M
authors.lastname: Luo
authors.affiliation: Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, People's Republic of China.
authors.forename: Wengang
authors.initials: W
authors.lastname: Wang
authors.affiliation: Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, People's Republic of China.
authors.forename: Mingkui
authors.initials: M
authors.lastname: Shen
authors.affiliation: Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, People's Republic of China. xialeigu1@126.com.
authors.forename: Lei
authors.identifier: http://orcid.org/0000-0003-1105-2239
authors.initials: L
authors.lastname: Xia
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D006801:Humans; D011859:Radiography / Q000639:trends; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome
keywords: Adolescent idiopathic scoliosis; Anterior approach; Lenke 5C; Meta-analysis; Posterior approach