Comparing Posterior Minimally Invasive Surgery versus Open Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis

Introduction: Adolescent idiopathic scoliosis (AIS) management has increasingly explored minimally invasive surgery (MIS) as an alternative to the traditional open posterior spinal fusion (PSF). This updated systematic review and meta-analysis aims to compare MIS with PSF in AIS patients, focusing on deformity correction, perioperative outcomes, and complication rates.

Methods: comprehensive search of PubMed, Embase, and Cochrane Library databases was conducted through August 2024. Studies comparing MIS and PSF for AIS were included if they provided data on deformity correction (Cobb angle and correction rate), perioperative parameters (estimated blood loss [EBL], operative time [ORT], length of hospital stay [LOS]), and complication rates. Statistical heterogeneity was evaluated using the I² statistic, and a random-effects model was applied if heterogeneity was significant.

Results: A total of 14 studies comprising 1,035 AIS patients (453 MIS, 582 PSF) met inclusion criteria. MIS showed significantly less estimated blood loss (EBL) than PSF, with a weighted mean difference (WMD) of -212.6 mL (95% CI: -250.8 to -174.4, p < 0.001), and a lower transfusion rate (RR 0.28; 95% CI: 0.18 to 0.43, p < 0.001). Length of hospital stay (LOS) was also shorter in the MIS group (WMD -1.34 days; 95% CI: -2.15 to -0.53, p = 0.001), while operative time (ORT) was notably longer for MIS (WMD 82.4 minutes; 95% CI: 45.6 to 119.2, p < 0.001). However, PSF provided superior correction rates and functional outcomes, as evidenced by a higher overall correction rate (WMD -1.7%; 95% CI: -3.6 to -0.2, p = 0.04) and improved functional scores at two-year follow-up. Both MIS and PSF demonstrated comparable infection and hardware complications (RR 1.12; 95% CI: 0.78 to 1.61, p = 0.53).

Conclusion : While PSF achieves superior correction rates and functional outcomes in AIS treatment, MIS offers a favorable perioperative profile, with reduced blood loss, and shorter hospital stays, though at the expense of increased operative time. The results support MIS as an alternative for patients emphasizing reduced perioperative impact, while PSF remains advantageous for those prioritizing optimal correction.