Article

Systematic review was conducted to compare effectiveness and safety of
anterior and posterior surgical approach in 3D correction of adolescent
idiopathic thoracic scoliosis. METHODS: Data sources were MEDLINE and SCOPUS
databases. We included studies on the use of either anterior or posterior
instrumentation, or their combination, in surgical correction of adolescent
idiopathic thoracic scoliosis,
with at least 10 enrolled patients, aged less than
20 years at the time of surgery, and a follow-up of at least 24 months. A study
was eligible if it reported the number of patients, mean estimate and dispersion
of three key outcome measures (frontal and sagittal Cobb angle, apical vertebra
rotation according to Perdriolle) at three measurement points (preoperatively,
postoperatively, at follow-up). The quality of studies was assessed using the
scale by Pilkington. RESULTS: Although 24 articles met the inclusion criteria, no
randomized controlled trials (RCT) was identified. None of the articles was of
high quality. Both instrumentations provided a similar degree of reduction of
frontal Cobb angle. Long-term effects of surgical correction on the sagittal Cobb
angle seemed to be more stable in patients treated by posterior approach, while
the anterior approach was more effective in the reduction of apical vertebral
rotation. The surgery parameters were more favorable for anterior approach,
particularly for the number of fused vertebrae.
CONCLUSIONS: Although the
available evidence favors neither of the two approaches, our study revealed
several important issues: the reports are heterogeneous and provide incomplete
relevant information. High quality studies, particularly RCT, are called for.
LEVEL OF EVIDENCE: Level II.
CI - Copyright (c) 2012. Published by Elsevier Masson SAS.

Langue : FRANCAIS