Utilization of posterior column osteotomies with posterior spinal fusion for correction of Lenke type 5 adolescent idiopathic scoliosis: a systematic review.

Abstract

Posterior spinal fusion (PSF) is a common treatment for Lenke type 5 adolescent idiopathic scoliosis (AIS). Posterior column osteotomies (PCOs) can be added to increase flexibility and facilitate deformity correction, but their routine value in thoracolumbar/lumbar curves remains unclear. This systematic review therefore evaluates the utilization of PCOs in published Lenke 5 AIS literature, comparing radiographic outcomes of PSF with versus without PCOs. A systematic review was performed according to PRISMA guidelines. Medline, Embase, and Cochrane were searched from inception through December 2025 for studies evaluating Lenke 5 AIS treated with posterior thoracolumbar/lumbar fusion with or without PCOs. Eligible studies reported preoperative and postoperative coronal and sagittal radiographic measurements. Descriptive pooled means and standard deviations were calculated, and between-group comparisons were performed on pre-to-post radiographic changes. 35 studies met inclusion criteria, analyzing 2108 patients. PCOs were used in 21.7% of pooled patients: 5 studies (490 patients) evaluated PSF + PCO and 30 studies (1618 patients) evaluated PSF alone. Mean thoracolumbar/lumbar Cobb correction was 79.22% in PCO cohorts versus 74.07% in non-PCO cohorts (p = 0.11). No significant between-group differences were identified in change in minor thoracic Cobb angle (p = 0.29), coronal balance (p = 0.31), thoracic kyphosis (p = 0.85), lumbar lordosis (p = 0.36), thoracolumbar kyphosis (p = 0.39), or sagittal vertical axis (p = 0.92). In the published literature on Lenke 5 AIS, PCOs are not routinely utilized during PSF and were not associated with significantly improved coronal or sagittal radiographic correction compared with PSF alone. Current evidence may better support selective case-by-case use of PCOs rather than routine use.