Is Anterior Release Obsolete or Does It Play a Role in Contemporary Adolescent Idiopathic Scoliosis Surgery? A Matched Pair Analysis

J Pediatr Orthop. 2020 Mar;40(3):e161-e165. doi: 10.1097/BPO.0000000000001433.


Study design: A retrospective analysis of a prospectively collected database was performed.

Objective: The purpose of this study is to compare 3-dimensional correction associated with the anterior release (AR) and contemporary posterior instrumentation versus posterior-only surgery.

Summary of background data: The role of AR as a tool in the treatment of adolescent idiopathic scoliosis (AIS) has seen a decline with the popularization of thoracic pedicle screw instrumentation.

Methods: Five surgeons were queried for all surgical thoracic AIS cases from 2003 to 2010 treated with thoracoscopic AR/fusion and contemporary posterior instrumentation and fusion and thoracic pedicle screw instrumentation (>80% screws) with 2-year follow-up. These cases were then matched with posterior spinal fusion only cases from a multicenter prospective database. The 2 groups were matched on the basis of major curve magnitude within 5 degrees, T5-T12 kyphosis within 9 degrees, and angle of trunk rotation within 9 degrees. Radiographic and clinical parameters were compared for the 2 groups. Continuous variables were analyzed with analysis of variance and categorical dependent variables with the χ test.

Results: A total of 47 cases of AR were matched to 47 (1:1 match) posterior spinal fusion cases. Preoperative parameters were similar between groups (P>0.05). Postoperatively, AR cases had a lower major curve (20 vs. 25 degrees, P=0.034; 72% vs. 66% correction, P=0.037). T5-T12 kyphosis was greater in the AR cases (26 vs. 20 degrees; P=0.005). The angle of trunk rotation was similar for the groups. Anchor density was lower in the AR group (1.6 vs. 1.9; P<0.0001). There were 3 complications associated with the AR: 1 pneumothorax and 2 conversions to minithoracotomies for failure to maintain single lung ventilation.

Conclusions: AR improves coronal and sagittal plane correction in contemporary AIS surgery with a satisfactory complication profile with less pedicle screw density required for clinically similar corrections. A further prospective study on the benefits of AR may help define specific indications.

MeSH terms

  • Adolescent
  • Female
  • Humans
  • Kyphosis* / diagnosis
  • Kyphosis* / etiology
  • Kyphosis* / surgery
  • Male
  • Matched-Pair Analysis
  • Pedicle Screws
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / etiology
  • Radiography / methods
  • Retrospective Studies
  • Scoliosis* / complications
  • Scoliosis* / diagnosis
  • Scoliosis* / surgery
  • Spinal Fusion* / instrumentation
  • Spinal Fusion* / methods
  • Thoracic Vertebrae* / diagnostic imaging
  • Thoracic Vertebrae* / surgery
  • Treatment Outcome