Side of surgical approach for lumbar scoliosis
| Consideration | Convex | Concave |
|---|---|---|
| Proponents | Dwyer, Zielke, Kaneda | McAfee, Pimenta, Akbarnia |
| Distance from spine to skin | Apex of curve is closer to skin incision | Concave bridging osteophytes are closer to skin incision |
| Size of approach | More “extensile” due to diverging direction of disk | Minimally invasive surgery due to converging pointing of |
| spaces | disk spaces (Fig. 6) | |
| OR positioning | Flat lateral decubitus Hinging OR table accentuates deformity | Hinged radiolucent table OR table assists reduction of scoliosis and lateral subluxation |
| Bridging osteophytes | Key area requiring osteotomies are on contralateral side of disk space | Ipsilateral disk space Direct vision |
| Instrumentation | Instrumentation is on “tension” side of scoliotic curvature so rods bear correction force | Load-bearing PEEK implants with large footprint maintain correction—spacers counteract compression |
| Ideal curve | More useful in thoracolumbar spine (apex T12 or L1) due to production of kyphosis | Lumbar curves (apex L2 + below), more effective restoration of lumbar lordosis |
Abbreviations: OR, operating room; PEEK, polyetheretherketone.