The Role of Anterior Correction and Release in Adolescent Idiopathic Scoliosis Surgery: A Summarised Mini- Comprehensive Review of Outcomes from Major Studies

Abstract

Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional spinal deformity affecting coronal, sagittal, and axial planes, with controversy persisting over the role of anterior release in surgical correction. Historically used to enhance flexibility through anterior column shortening, anterior approaches have largely been replaced by posterior-only fusion techniques utilizing modern pedicle screw instrumentation. This study comprehensively reviewed and summarised the current evidence of major studies on anterior correction and release in AIS, emphasizing radiographic correction, sagittal balance, pulmonary outcomes, and perioperative morbidity. A comprehensive literature search of PubMed, Scopus, and Web of Science identified seven eligible studies published between 2013 and 2025, encompassing over 600 patients, predominantly with Lenke type 1 and 2 curves. Anterior correction achieved a mean coronal improvement of 58-72%, with postoperative Cobb angles reduced to 20-30° and sagittal alignment generally maintained within normal kyphotic ranges. Flexibility increased markedly following anterior release, but operative time and blood loss were greater compared with posterior-only fusion. Pulmonary function showed a transient decline postoperatively with recovery by one year, while overall complication rates ranged between 8% and 15%, primarily mild respiratory events. Comparative analyses revealed that anterior correction offers equivalent coronal and axial correction with fewer fused levels but higher perioperative morbidity. Posterior-only fusion demonstrated shorter operative times, less blood loss, and fewer complications, maintaining comparable correction and balance. Despite advances in three-dimensional imaging and instrumentation, the optimal role of anterior release in AIS remains uncertain and warrants further prospective, comparative investigation.