Comparative analysis of modified posterior mini-open surgery versus standard open posterior approach for adolescent idiopathic scoliosis correction: a prospective study.

Abstract

Purpose: Adolescent idiopathic scoliosis (AIS) surgery aims to achieve optimal deformity correction while minimizing complications. The standard open posterior approach (OS) is effective but associated with significant soft tissue disruption and prolonged recovery. The modified mini-open surgery (MS) technique offers a less invasive alternative, potentially reducing surgical morbidity while maintaining comparable correction.

Methods: In this prospective comparative study, 60 Lenke type 1 AIS patients with single thoracic curves were randomized to MS (n = 30) or OS (n = 30) groups. The MS technique utilized three midline incisions, a muscle-splitting approach, and selective arthrodesis at instrumented levels. Outcomes included deformity correction, intraoperative blood loss, hospital stay, postoperative pain (VAS), scar satisfaction, fusion rates, and complications at 2 years.

Results: Both groups achieved comparable correction with no loss at 2 years (MS: 79.7% ± 8.0%; OS: 85.0% ± 7.4%; p > 0.05). The MS group had reduced intraoperative blood loss (383.3 ± 82.9 mL vs. 720.2 ± 74.3 mL; p = 0.019), shorter hospital stays (6.2 ± 0.3 vs. 7.4 ± 1.2 days; p = 0.044), and lower VAS scores at discharge (2.9 ± 1.8 vs. 3.9 ± 1.4; p = 0.02) and 2 years (1.5 ± 0.5 vs. 2.0 ± 0.7; p = 0.03). Scar satisfaction was higher in the MS group (4.5 ± 0.3 vs. 2.8 ± 0.6; p = 0.02). No pseudoarthrosis or complications occurred in either group.

Conclusion: The MS approach offers comparable correction to OS with reduced morbidity and superior cosmesis.