The effectiveness of selective thoracic fusion for treating adolescent idiopathic scoliosis: a systematic review protocol.

Abstract

REVIEW QUESTION / OBJECTIVE The objective of this review is to assess the effectiveness of selective thoracic fusion as a form of treatment in adolescent idiopathic scoliosis. This will be compared with all other forms of operative management for major structural thoracic curves. INCLUSION CRITERIA Types of participants A comprehensive and exhaustive literature search will be conducted for studies that include children aged 10-18 years with adolescent idiopathic scoliosis who have a scoliosis curve with a thoracic component that is described as structural (as described by the Lenke classification). In addition those with congenital, neuromuscular or syndromic causes for their scoliosis or any previous spinal fusion will be excluded. Types of intervention This review will consider studies that evaluate fusion of the thoracic curve with distal fusion no lower than L1. Both anterior and posterior approaches will be included; however any patient who receives both will be excluded. All forms of instrumentation for fusion such as pedicle screws, hooks and rods will be included. This will be compared where possible to any other surgical fusion for a structural thoracic curve. This will include studies that compare selective and non-selective spinal fusion in the same article, or selective spinal fusion only, but not non-selective spinal fusion only. Types of outcomes Primary outcomes include: Functional/Quality of life survey (SRS- 22, SRS-24, SRS-30 or similar). Complication rate – including, but not limited to, adding on, coronal imbalance, junctional kyphosis and re-operation. Respiratory function. Secondary outcomes include: Postoperative main thoracic Cobb angle, and average change in angle. Postoperative compensatory lumbar Cobb angle, and average change in angle. Coronal balance. Sagittal balance. Apical vertebral rotation and change.