Title: Utilization of posterior column osteotomies with posterior spinal fusion for correction of Lenke type 5 adolescent idiopathic scoliosis: a systematic review

Senior Author: James D. Lin, MD, MS, Assistant Professor of Orthopedics (Spine Surgery), Associate Director of the Mount Sinai Spine Surgery Fellowship for the Mount Sinai Health System, Site Director of Spinal Deformity Surgery at The Mount Sinai Hospital

Bottom line: Adolescent idiopathic scoliosis is a complex three-dimensional spinal deformity that affects otherwise healthy adolescents, typically between the ages of 10 and 18. Posterior spinal fusion (PSF) is a commonly used surgical treatment for patients with Lenke type 5 curves, which primarily involve the thoracolumbar or lumbar spine. Posterior column osteotomies (PCOs) may be added during surgery to increase spinal flexibility and facilitate deformity correction, particularly in patients with more rigid curves. However, the role of PCOs in thoracolumbar curves has not been clearly established.

In this systematic review, researchers evaluated previously published studies of Lenke type 5 adolescent idiopathic scoliosis to examine the use of PCOs in combination with PSF and compare radiographic outcomes with PSF performed without PCOs.

Across 35 studies involving more than 2,100 patients, the researchers found that patients who underwent PSF with PCOs had similar overall correction compared with patients who underwent PSF without PCOs. These findings highlight the importance of individualized surgical planning and suggest that PCOs may be useful in select patients with larger or stiffer curves.

Why this study is unique: This is the first systematic review specifically focused on the use of PCOs in patients with Lenke type 5 adolescent idiopathic scoliosis. The review includes data from 35 studies involving 2,108 patients, making it the largest review to date examining this specific surgical question.

Why this study is important: Scoliosis surgery is highly individualized, and the appropriate surgical technique depends on factors such as curve size, flexibility, spinal alignment, and the goals of correction. PCOs can provide additional flexibility to the spine and may facilitate correction in patients with more challenging or rigid deformities.

At the same time, these additional surgical techniques may not be necessary for every patient. Understanding when PCOs are most likely to provide meaningful benefit can help surgeons tailor surgery to each patient's anatomy and deformity while avoiding unnecessary additional procedures.

How the research was conducted: Researchers reviewed 35 previously published studies from medical centers around the world. Three major medical databases were searched to identify studies evaluating surgical treatment of Lenke type 5 adolescent idiopathic scoliosis that met the study's inclusion criteria.

Results: Patients who underwent PSF with a PCO had an average correction of approximately79 percent of their main spinal curve, compared with approximately 74 percent among patients who underwent PSF without a PCO.

Both groups demonstrated improvements in spinal alignment and balance following surgery.

What this study means for patients: The findings suggest that many patients with Lenke type 5 scoliosis may achieve substantial correction with posterior spinal fusion alone, while PCOs may provide additional value for patients with specific characteristics, such as larger or stiffer curves.

For patients, the most appropriate surgical approach depends on the individual characteristics of their spinal deformity. If a surgeon recommends a PCO, the decision may reflect factors such as curve stiffness, alignment, and the amount of correction needed to achieve the desired surgical result.

What this study means for doctors: These findings support an individualized approach to the use of PCOs in Lenke type 5 scoliosis. Rather than routinely incorporating PCOs into every procedure, surgeons can consider the patient's curve characteristics, flexibility, and overall alignment when determining whether an osteotomy is appropriate.

The findings also underscore the need for continued research to better define which patients are most likely to benefit from these additional techniques.

What the next steps are for this work: These results identify several important areas for future study, including how the use of these osteotomy techniques has evolved over time with advances in surgical techniques and technology, as well as how we can better identify and select patients who are most likely to benefit from these more advanced procedures.

(Newswise/HG)