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- Talk
- 22/09/2022
- UK
Systematic Review and Meta-Analysis: Does Anterior Release Still Have a Role in Severe Thoracic Adolescent Idiopathic Scoliosis?
Description
In this presentation, Laasya Dwarakanath discusses a study exploring the role of anterior release in severe thoracic adolescent idiopathic scoliosis (AIS). Conducted at the Royal Orthopedic Hospital in Birmingham, the study investigates the comparative effectiveness of anterior-posterior spinal fusion (APSF) versus posterior spinal fusion (PSF) based on various clinical outcomes.
The presentation begins with an overview of spinal surgical approaches, emphasizing the anterior release technique which, historically, has been thought to enhance flexibility and correction rates due to the release of the anterior longitudinal ligament and disk removal. Despite the advantages of anterior approaches such as fewer fusion levels, improved cosmetic results, and reduced blood loss, complications like hyperkyphosis and shoulder asymmetry remain concerns.
Dwarakanath outlines the study's aim to compare surgical approaches by analyzing variables such as Cobb angle corrections, complication rates, pulmonary function, and patient-reported outcome measures (PROMS). The research methodology, including a comprehensive database search and quality assessments, is detailed, highlighting the stringent inclusion criteria and statistical analysis methods employed.
The follow-up results reveal that while some studies indicate a trend toward superior Cobb angle correction in the APSF group, the findings are not statistically significant. Complication rates were found to be higher in the APSF cohort as well but again lacked statistical significance. The meta-analysis notes limitations such as biased studies, inconsistent reporting, and inadequate overall quality of evidence.
In conclusion, Dwarakanath emphasizes that current evidence does not strongly favor either surgical option for treating large thoracic curves in AIS, calling for more robust multicenter trials to guide clinical decisions. The presentation ends with a reflection on the necessity for ongoing research and the tentative recommendations for surgeons based on existing data until new evidence surfaces.