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Mid- to Long-Term Outcomes in Adolescent Idiopathic Scoliosis After Instrumented Posterior Spinal Fusion: A Meta-Analysis

Lykissas, Marios G., MD, PhD; Jain, Viral V., MD; Nathan, Senthil T., MD; Pawar, Varun, MD; Eismann, Emily A., MS; Sturm, Peter F., MD; Crawford, Alvin H., MD

doi: 10.1097/BRS.0b013e31827ae3d0
Literature Review
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Study Design. Meta-analysis on mid- to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion.

Objective. To compare mid- to long-term outcomes and complications of the most commonly used instrumentation systems in adolescent idiopathic scoliosis.

Summary of Background Data. A meta-analysis of mid- to long-term results of different methods of instrumentation, including the most currently used all-pedicle screw construct, is lacking.

Methods. A structured literature review was conducted for studies concerning management of patients with adolescent idiopathic scoliosis with instrumented posterior fusion. Pooled means, standard deviations, and sample sizes were either identified or calculated on the basis of the results of each study.

Results. Meta-analyses were performed on outcomes from 27 studies. Overall, 1613 patients who had been treated with Harrington rods, 361 patients who had undergone Cotrel-Dubousset instrumentation, and 298 patients who managed with all-pedicle screw constructs were reviewed. The mean follow-up was 14.9 years. Cotrel-Dubousset and pedicle screw instrumentations achieved a significantly greater degree of correction of the thoracic curve than Harrington rods (40.3° vs. 14.7°; P < 0.001 and 21.9° vs. 14.7°; P = 0.005, respectively). Cotrel-Dubousset technique achieved a significantly higher degree of correction than all-pedicle screw construct in both the thoracic (40.3° vs. 21.9°, respectively; P < 0.001) and lumbar curves (37.2° vs. 16°, respectively; P < 0.001). Similarly, Cotrel-Dubousset construct achieved a greater correction of both thoracic kyphosis (33.5° vs. 23°, respectively; P < 0.001) and lumbar lordosis (46° vs. 50.7°, respectively; P = 0.002) than pedicle screws. All-pedicle screw fixation was associated with the lower risk of pseudarthrosis, infection, neurological deficit, and reoperation.

Conclusion. This study confirms the negative effect of Harrington rods on sagittal alignment. We further found that the degree of correction in the coronal and sagittal planes was higher after Cotrel-Dubousset instrumentation than all-pedicle screw fixation. All-pedicle screw constructs offered the lower risk of mid- to long-term complications and revision surgery.

A meta-analysis was conducted on mid- to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion. Degree of correction in both coronal and sagittal planes was higher after Cotrel-Dubousset instrumentation than all-pedicle screw fixation. All-pedicle screw constructs offered a lower risk of complications and revision surgery.

From the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Address correspondence and reprint requests to Viral V. Jain, MD, Cincinnati Children's Hospital Medical Center, Division of Orthopaedic Surgery, 3333 Burnet Avenue, MLC 2017, Cincinnati, OH 45229; E-mail: viral.jain@cchmc.org

Acknowledgment date: July 19, 2012. First revision date: September 10, 2012. Acceptance date: October 19, 2012.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, stock/stock options.

© 2013 Lippincott Williams & Wilkins, Inc.