Combined anterior-posterior versus posterior only approach for surgical management of adult spinal deformity: a systematic review and meta-analysis of comparative studies

Purpose: The purpose of this systematic review and meta-analysis was to examine the clinical outcomes and complication rates for fusion procedures of adult spinal deformity (ASD) performed via an anterior-posterior approach as compared to a posterior-only approach to guide surgical decision-making. Numerous surgical techniques exist for operative management of ASD; however, no systematic review and meta-analysis exists comparing combined anterior-posterior approaches to posterior-only approach, despite significant interest in the current literature.

Methods: Four databases were used to collect articles from database inception until September 9th, 2023. Inclusion criteria was articles that examined both anterior-posterior or posterior only surgical approach, adult patients, comparative studies, and articles in English.

Results: Seven comparative articles met the inclusion criteria. Included patients had a frequency weighted (FW) mean age of 60.2 ± 5.1 years and a FW mean follow-up of 40.4 ± 12.5 months. Qualitative data did not favor either group in terms of length of stay, radiographic outcomes, or functional outcomes. There was a total of 306 complications in the Anterior-Posterior group with a complication rate per patient of 1.0 ± 0.9 complications whereas there was a total of 380 complications in the Posterior Only group with a complication rate per patient of 1.0 ± 1.2 complications. Meta-analysis of specific complications found no significant difference in revision rate, dural tear rate, neurological complication rate, infection rate, or pseudoarthrosis rate.

Conclusion: Surgical management for ASD may provide comparable results in terms of surgical parameters, radiographic outcomes, functional outcomes, and complication rates, irrespective of surgical approach.