Adolescent Idiopathic Scoliosis: Is the Feasible Option of Minimally Invasive Surgery using Posterior Approach?

Study design: Systematic review and meta-analysis.Purpose: To perform a systematic review and meta-analysis of previous studies on minimally invasive scoliosis surgery (MISS) in adolescent idiopathic scoliosis (AIS).Overview of literature: There is some conflicting data on MISS in AIS compared to conventional open scoliosis surgery (COSS).Methods: A systematic literature search was conducted in Medline, Embase, and Cochran library, including studies reporting outcomes for MISS in AIS. The meta-analysis compared the operative, radiological, and clinical outcomes and complications between MISS and COSS in AIS.Results: Of the 208 records identified, 15 nonrandomized studies with 1,369 patients (reviews and case reports are excluded) are finally included in this systematic review and meta-analysis. The mean scale was 6.1, and 8 of the included studies showed satisfactory quality using the Newcastle-Ottawa scale. For operative outcomes, MISS had significant benefits in terms of estimated blood loss (standard mean difference [SMD]; -1.87; 95% CI: -2.94 to -0.91) and hospitalization days (SMD -2.99; 95% CI: -4.45 to -1.53) compared to COSS. However, COSS showed significant favorable outcomes for operative times (SMD 1.71; 95% CI: 0.92 to 2.51). No significant differences existed for radiological outcomes, including Cobb's angle of the main curve and thoracic kyphosis. For clinical outcomes, MISS showed significant benefits on VAS (SMD -0.91; 95% CI: -1.36 to -0.47). Overall complication rates of MISS were similar to that of COSS (SMD 0.96; 95% CI: 0.61 to 1.52).Conclusions: The MISS using posterior approach provides equivalent radiological and clinical outcomes, and complication rates compared to COSS. Considering the lower estimated blood loss, shorter hospitalization days, but longer operative times in MISS, COSS is still the mainstay of surgical treatment in AIS but MISS using posterior approach is also one of surgical options as surgeon's choice in the case of moderate AIS.