Comparison Of Clinical Efficacy Between Anterior–posterior Fusion And Posterior-only Fusion For Scheuermann's Kyphosis:A Meta-analysis

Background:Scheuermann's kyphosis(SK)is a kind of adolescent idiopathic thoracic or thoracolumbar structural kyphosis.Posterior-only internal fixation(PO)and combined anterior/posterior fusion(AP)are commonly used for treatment of kyphosis deformity correction.Both both of PO and AP can achieve satisfactory results after operation.However,there are divergent opinions on the long-term effect,postoperative complications and other related factors,so there is no strong evidence and consensus on the safety and efficacy of the two surgical methods.There are still many controversies about the choice of two surgical methods in clinic.Objective:Using the method of Meta-analysis,systematically evaluate the clinical efficacy between PO and AP for SK.Our aim is to use evidence-based medicine to provide strong evidence for clinicians to choose treatment options.Method:We conducted a systematic literature review.By searching PubMed,Cochrane Library,Embase database and Web of Science database,we collected all of the clinical studies about the comparison of PO and AP for SK are performed from Jan2000 to Oct 2018,the retrieval language was limited to English.We also retrieved the references that may be selected.Firstly,according to inclusion exclusion criteria,we strictly screen and evaluate the title,abstract and full text of the literature.Then we extract the data of the observation indicators included in the study,,and finally all data were analyzed by Revman Software(Version 5.3).Result:9 prospective cohort studies,were included in this Meta-analysis.A total of 476 patients were enrolled in the study.Overall,there were 220 patients who underwent PO group with 256 patients underwen AP group.Compared to the AP group,the total complication rate of PO group[OR=0.36,95%CI(0.22,0.58),Z=4.12,P<0.0001]was lower.Others,there was no statistical difference found between PO and AP groups in terms of preoperative cobb [SMD=-0.16,95%CI(-0.34,0.03),Z=1.68,P=0.09],postoperative cobb [SMD=-0.15,95%CI(-0.69,0.39),Z=0.54,P=0.59],reoperation rate [OR = 0.73,95% CI(0.73,95% CI(0.40,1.33),Z = 1.03,Z = 1.03,P= 0.30],the incidence of PJK [OR = 0.74,95% CI(0.25,2.22),Z = 0.54,P = 0.59],C7 plumb line [SMD=-0.12,95% CI(-0.37,95% CI(-0.37,0.13),follow-up cobb[SMD=-0.23,95%CI(-0.74,0.27),Z=0.90,P=0.37],the rate of correction loss[SMD=0.11,95%CI(-0.28,0.50),Z=0.56,P=0.58].Conclusion:PO and AP can achieve satisfactory orthopaedic purposes,and there is no statistical difference in the long-term effect.PO and AP share the similar clinical improvement,but the incidence of complications after PO is lower,so it has more advantages in safety.However,this conclusion still needs further confirmation by more high-quality studies.