Correction of adolescent idiopathic scoliosis using the convex rod de-rotation maneuver: a systematic review

Adolescent idiopathic scoliosis (AIS) is a spinal deformity affecting 2-3% of the population, predominantly girls. Standard treatment involves posterior spinal fusion (PSF) with pedicle screws, which, despite being effective, carries risks of complications from screw misplacement. Convex single-rod de-rotation techniques have recently emerged as promising correction maneuvers. This review aims to evaluate their safety and effectiveness.

A systematic review adhering to PRISMA guidelines was performed. Literature from PubMed/MEDLINE, SCOPUS, CINAHL, EMBASE, and CENTRAL up to July 2023 was analyzed. The included studies comprised AIS patients treated with the convex rod de-rotation technique, assessing pre- and postoperative major curve angles and thoracic kyphosis using the Cobb method, percentage of curve correction, loss of correction, and perioperative complications.

Of 661 studies initially identified, 11 met the inclusion criteria, involving 511 AIS patients (mean age 15.02 years) treated with convex rod de-rotation. The average follow-up period was 33.1 months. Curve magnitudes ranged from 41.9° to 110°, with a mean correction rate of 73% (43.5%-89%). Thoracic kyphosis ranged from a mean value of 21.3° (range 10-74) before treatment to a mean value of 26.2° (range 6-49) at the final follow-up. No significant complications were reported.

The convex rod de-rotation technique offers substantial curve correction with minimal complications. Nevertheless, additional studies are needed to standardize surgical protocols and validate long-term outcomes. Limitations such as small sample sizes and methodological variability underscore the need for further research to confirm these findings and refine the approach.