Introduction:

Approaches to surgical treatment of idiopathic scoliosis with a major lumbar/thoracolumbar curve (Lenke type 5) remain debatable1 regarding choice of anterior or posterior approach,2 optimal instrumentation levels,3,4 and complication prevention.5 Posterior correction and instrumentation have become the “gold standard” for surgical treatment of any type of idiopathic scoliosis ever since the introduction of the Harrington rod,6 and its analogues.7 Surgical correction of scoliosis went through a rapid development phase after the introduction of third-generation instrumentation into clinical practice.8

Simultaneously with the development of posterior spine surgery, improvements in the principles and techniques for anterior surgery took place. Dwyer proposed in 1974 an anterior correction system,9 which was later modified10, 11, 12 and widely used.13,14

According to the Lenke classification, types 1 and 5 are optimal for anterior correction.1 Namely, rigid anterior scoliosis correction has a number of significant advantages compared to posterior interventions: it allows to reduce the number of instrumented segments,15 allows for correction comparable to posterior instrumentation,16, 17, 18, 19 diminishes the risks of neurological complications,20,21 as well as the rate of complications associated with wound healing.19 Additionally, female patients experience less difficulties during pregnancy and childbirth (pregnancy proceeds as in healthy individuals)22 and the long-term outcomes have proven to be excellent (more than 15 years follow-up).23 In general, there is little difference in radiological or clinical outcomes in patients with Lenke type 5 scoliosis treated through anterior or posterior approaches.24 Still, the risks and benefits of each approach are considered individually for each patient.24

More recently, dynamic scoliosis correction approaches have been gaining traction, primarily aiming at growth modulation in pediatric patients25, 26, 27, 28 and selectively as an option for skeletally mature patients.5,29 Dynamic correction allows for preserved mobility in the instrumented region, which has been confirmed by biomechanical studies.30 Furthermore, dynamic correction allows patients to return to their usual physical activity and sports within a relatively early timeframe.31

Despite the growing number of studies involving dynamic correction of spinal deformities in patients with idiopathic scoliosis, studies comparing various methods of anterior correction have not yet been published.