Adolescent scoliosis: ~79% correction with osteotomies, ~74% without

A surgeon planning scoliosis surgery has two broad options to consider: posterior spinal fusion (PSF) alone, or PSF combined with posterior column osteotomies (PCOs), additional procedures that can make the spine more flexible. In the largest review focused on this question, researchers found approximately 79% average correction with PCOs and approximately 74% without them in Lenke type 5 adolescent idiopathic scoliosis.

The review, published in Spine Deformity, brought together 35 studies involving 2,108 patients from medical centers around the world. Of those patients, 490 underwent PSF with a PCO, while 1,618 underwent PSF without one. Both groups showed improved spinal alignment and balance after surgery, and the researchers reported similar overall correction between the approaches.

That distinction matters because PCOs are not presented as a routine upgrade. The techniques can provide additional flexibility and may help with more challenging deformities, particularly when a curve is larger or stiffer. Many patients, the review suggests, may achieve substantial correction with PSF alone.

The evidence also leaves questions open. The researchers reviewed previously published studies rather than running a single new comparison, and they call for further work to determine which patients are most likely to gain meaningful benefit. They also want to understand how these osteotomy techniques have changed as surgical methods and technology have advanced.

So what changes in practice? A recommendation for a PCO can reflect a patient's curve stiffness, alignment and desired degree of correction—not a need to use the extra procedure in every operation. For families, the review supports asking how those individual features change the balance between the added technique and the correction being sought.