Anterior-only approaches to scoliosis

Scoliosis is a three-dimensional spinal deformity for which surgery may be indicated when patients experience severe pain, curve progression, or progressive disability. Operative treatment has conventionally involved extensive posterior stabilization, either alone or in combination with anterior release procedures. Anterior-only approaches have a more limited role, but they should be considered in the appropriate setting when addressing this disease. Some advantages of anterior-only approaches to scoliosis include greater corrective ability with a greater fusion rate while mandating fewer motion segments to be involved in the instrumented construct. Preventing denervation of the posterior paraspinal musculature is also desirable and is inherently provided for by the anterior approach. Disadvantages include pulmonary morbidity associated with violating the thoracic cavity, as well as post-thoracotomy chronic pain. There are also limitations in the indications for which anterior-only surgery can be performed, and these will be discussed along with treatment options. Technological advances, including minimally invasive thoracic access as well as evolving instrumentation, may minimize the stated disadvantages and expand the scope of scoliosis cases that may be treated by anterior-only approaches. Hence, the enhanced corrective ability and biomechanical advantages of the anterior column can be used in the treatment of these patients. Although the indications for anterior-only strategies in scoliosis remain limited, such operations should be considered in the appropriate setting when addressing spinal deformity.