# Posterior-Only Approach for the Treatment of Adolescent Idiopathic Scoliosis Using Pedicle Screw Fixation: Our Experience

## TL;DR

This study shows that a posterior-only spinal surgery using pedicle screws effectively treats severe adolescent scoliosis with good long-term results.

## Contribution

The study provides mid-term clinical and radiological evidence supporting the use of a posterior-only approach for treating severe adolescent idiopathic scoliosis.

## Key findings

- 97.8% of patients showed significant sagittal balance improvement five years post-surgery.
- Coronal balance improved from 58.2% pre-surgery to 98.2% five years post-surgery.
- Most patients reported mild back pain and high satisfaction five years after surgery.

## Abstract

Objective: The study aims to evaluate clinicoradiological outcomes five years post-surgery, emphasizing the mid-term efficacy of posterior spinal instrumentation (PSI) and fusion using a posterior-only approach for the surgical management of adolescent idiopathic scoliosis (AIS).

Study design: This was a retrospective observational study.

Summary of background: AIS is the most prevalent spinal deformity among children. It is a three-dimensional deformity that is characterized by varying sagittal, coronal, and rotational alignment of the spine. For severe (Cobb angle 45° to 59°) and very severe (Cobb angle > 60°), PSI, along with anterior release, was traditionally the preferred method.

Methods: This study focuses on a cohort of 225 individuals who fulfilled the inclusion criteria and underwent posterior-only surgery utilizing all pedicle screw constructs for the treatment of AIS from January 2012 to December 2018. Data from the electronic records at Dr. Ziauddin Hospital, Karachi, Pakistan, were extracted to analyze functional and radiographic outcomes up to five years post surgery.

Results: The majority of our patients were females (162, 72%), with a mean age of 17.5 years for males and 14.9 years for females. The majority of AIS patients in the study were Lenke type 1 (135, 60%). In patients with neutral balance, the sagittal balance significantly improved in 204 (90.7%) at one year and 220 (97.8%) at five years. Our patients' coronal balance at one year after surgery was 216 (96%) and 221 (98.2%) at five years, as opposed to 131 (58.2%) before surgery. The mean immediate corrected angle was 8.71°, the mean one-year postoperative angle was 9.47°, and the mean five-year postoperative angle was 10.87°, compared to a mean of 72.93° preoperatively. The Oswestry Disability Index (ODI) showed significant improvement one year post operation. By five years, no patients had severe disability, but nearly all (219, 97.3%) had mild, occasional back pain. The Spine Research Society Score-22 (SRS-22) outcome measure showed improvement from a mean score of 3.69 to 4.67. The greatest improvement was seen in satisfaction and self-perceived image components.

Conclusion: Our study confirms the efficacy of a posterior-only approach using pedicle screw instrumentation in achieving stable correction of severe and very severe AIS, with minimal reported complications like surgical site infection and a few requiring revision surgery.