Study design:

Systematic review and meta-analysis.

Objective:

This study aimed to compare the radiographical and clinical outcomes between anterior spinal fusion (ASF) and posterior spinal fusion (PSF) in Lenke type 5 adolescence idiopathic scoliosis (AIS).

Summary of background data:

PSF has been the standard operation for AIS. ASF can also achieve a good curve correction effect with fewer fusion segments and minor invasion of paraspinal structures.

Methods:

A systematic literature research was conducted in PubMed, Embase, Cochrane Library, and Web of Science. Use meta-analysis to compare the changes of thoracolumbar/lumbar (TL/L) and thoracic curves and other important outcomes between ASF and PSF.

Results:

A total of 427 ASF and 392 PSF patients from twelve studies were included. There was no significant difference in the correction degree of TL/L and thoracic curve between ASF and PSF (P>0.05), except for PSF had more compensatory correction degree of thoracic curve at postoperation (P<0.05). Besides, the loss of correction in thoracic curve in PSF at the last follow-up was significantly less than that in ASF (P<0.05). PSF presented larger change values of thoracic kyphosis (TK) and lumbar lordosis (LL) at the last follow-up (P<0.05). PSF showed a better effect in correcting trunk shift (TS) distance at the postoperation (P<0.05) but less TS distance correction from postoperation to last follow-up (P<0.05). There was no significant difference in the incidence of PJK and estimated blood loss between the two approaches (P>0.05). Moreover, ASF showed fewer fusion segments, but longer operation and hospital stay time (P<0.05).

Conclusion:

ASF could achieve an approximate correction effect of coronal curve and balance as PSF with fewer fusion segments. Spine surgeons should select an appropriate approach by considering the operation’s risks and benefits.

Level of evidence:

2.