Adolescent idiopathic scoliosis: current concepts of surgical management

Purpose of review The operative treatment of adolescent idiopathic scoliosis has been rapidly evolving. This review evaluates recent advances in the surgical management of this disease over the past year. Recent findings Modern posterior spinal segmental instrumentation and corrective techniques for spinal deformity have led to recent questioning of the need for preliminary anterior release for large curves. Several comparative studies have analyzed the safety and efficacy of various posterior anchors such as pedicle screws, apical sublaminar wires, and hybrid techniques. Thorascopic anterior spine instrumentation for scoliosis, despite its steep learning curve, has been shown to be an effective method for the correction of thoracic scoliosis. Proponents of this technique suggest that potentially fewer vertebrae are fused compared with posterior only techniques, and there is less blood loss, limited pulmonary morbidity, and preservation of posterior spinal musculature. Summary Several trends in surgical management of adolescent idiopathic scoliosis have been identified. These include the increasing use of pedicle screw segmental fixation in the thoracic spine for correction of large scoliosis curves greater than 708. Minimizing or avoiding violation of the chest wall cavity by eliminating the need for a preliminary anterior release and a concomitant thoracoplasty with these powerful posterior techniques of segmental instrumentation appears to preserve maximum long-term pulmonary function.