Burak ABAY, Hamisi MRAJA, İlyas DOLAŞ, Selhan KARADERELER, Meriç ENERCAN, Azmi HAMZAOĞLU, Emin ALICI
Journal of Turkish Spinal Surgery - 2026;37(EK-1):21-26
The surgical correction of adolescent idiopathic scoliosis (AIS) has transitioned from long, coronal-focused distraction constructs to more sophisticated three-dimensional (3D) strategies that prioritize physiologic alignment, shorter fusions, and reliable recovery. The Harrington era demonstrated that internal fixation could safely control deformity on a large scale, yet experience with thoracic hypokyphosis and limited axial control exposed the need for constructs that address rotation and the sagittal profile. Cotrel-Dubousset instrumentation reframed AIS as a rotational deformity and introduced deliberate 3D correction; comparative series subsequently documented improved sagittal restoration and reduced reliance on postoperative external immobilization compared with earlier systems. The widespread adoption of thoracic pedicle-screw constructs-and later, direct vertebral rotation-made strong multiplanar correction routine while allowing more selective, shorter fusions guided by the Lenke classification. Current decision-making fine-tunes implant strategy and perioperative care, rather than seeking a single "best" construct. Enhanced recovery pathways consistently shorten hospital stays and reduce blood loss without increasing complications, supporting broader implementation alongside modern anesthetic and analgesic techniques. Posterior minimally invasive scoliosis surgery can decrease blood loss and length of stay compared with open posterior spinal fusion, though operative time may be longer and radiographic outcomes may be similar, underscoring the role of case selection and surgeon experience. Image guidance and robotics may improve pedicle-screw accuracy, but large contemporary datasets warn of higher radiation exposure and modeled lifetime cancer risk with routine navigation in AIS, supporting selective use rather than default adoption. Recently, for skeletally immature patients who fail bracing, vertebral body tethering offers a motion-preserving, non-fusion alternative with meaningful correction but a non-trivial risk of reoperation, requiring careful counseling and follow-up.
