Posterior-only versus combined anterior-posterior approaches in severe rigid scoliosis: A systematic review and meta-analysis.

BACKGROUND

The optimal surgical strategy, whether to proceed with posterior-only or combined anterior-posterior correction for severe, rigid scoliosis, remains a topic of debate. This systematic review and meta-analysis compared radiological correction and perioperative outcomes between these two techniques.

METHODS

A systematic review and meta-analysis (PROSPERO: CRD420251142691) of PubMed, Embase, and Scopus identified studies of patients with severe rigid scoliosis treated by posterior-only or AP approaches. Data on demographics, deformity features, operative parameters, hospital stay, correction rates, and complications were extracted. Quality was assessed using the Newcastle-Ottawa Scale. A meta-analysis of operative and radiographic outcomes was performed using a random-effects model with inverse variance, pooling raw means or standardized mean differences (SMD), and assessing heterogeneity with I2 and Chi2.

RESULTS

Posterior-only and combined anterior-posterior (AP) approaches both achieved significant correction of coronal (SMD 4.58, 95 % CI 3.86-5.30) and sagittal (SMD 1.38, 95 % CI 0.13-2.63) Cobb angles. Posterior-only approaches were associated with shorter operative time (356.7 min) and lower intraoperative blood loss (2306 mL) compared with combined AP approaches. Hospital stay varied across studies (mean 18.7 days). Post-operative coronal and sagittal balance showed no significant differences from pre-operative alignment. Heterogeneity across studies was substantial, reflecting variations in technique and patient selection.

CONCLUSION

Posterior-only correction achieves comparable deformity correction and spinal balance to combined anterior-posterior approaches, with shorter operative time and lower blood loss. Careful patient selection remains essential, and further prospective studies are needed to validate these findings.