Posterior Only Versus Combined Anterior and Posterior Approaches to Lumbar Scoliosis in Adults

Abstract

Retrospective study. To compare the radiographic lumbar curve correction between a posterior only and combined anterior-posterior approach in patients with adult spinal deformity. In adolescent idiopathic scoliosis correction, posterior only has been compared with the combined anterior-posterior approach; however, there have been no corollary studies in adult scoliosis. Traditionally, rigid lumbar curves have been treated with a combined anterior and posterior approach; however, the absolute indications for this approach are unclear. A total of 180 patients with degenerative or adult idiopathic spinal deformity and curves measuring between 40 degrees and 70 degrees who underwent reconstructive spinal fusion. The minimum follow-up period was 28 months and average follow-up was 53 months. Of the 155 patients who underwent surgery, 80 underwent posterior only (35 with idiopathic and 45 with degenerative scoliosis) while 75 patients (30 with idiopathic and 35 with degenerative scoliosis) underwent combined anterior-posterior surgery. The groups were compared by age at operation, preoperative deformity, levels operated and postoperative correction and balance. There were no significant differences in sagittal and coronal plane curve and balance correction between the posterior only and the combined anterior-posterior groups. When the patients were subdivided into degenerative adult scoliosis and idiopathic adult scoliosis, there were again no significant differences in the sagittal and coronal curves or balance between the posterior only and combined anterior and posterior approaches. While the posterior only group and the same-day anterior and posterior surgery group had a similar major complication rate of 24% and 23%, respectively, patients who underwent staged anterior and posterior surgery had a major complication rate of 45%. When combined with extensive posterior releases, posterior only approach is just as effective as combined anterior and posterior surgery for adult lumbar scoliosis measuring between 40 degrees and 70 degrees .