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Evidence-Based Medicine Analysis of All Pedicle Screw Constructs in Adolescent Idiopathic Scoliosis

Study Design. Focus paper. Objective. To evaluate the current evidence-based medicine (EBM) literature in the use of pedicle screw constructs in patients with adolescent idiopathic scoliosis. Summary of Background. EBM has evolved over the past 20 years to provide a framework for the evaluation of therapy and the application of that assessment to a particular patient or a disease. Application of EBM analysis to spinal instrumentation, and specifically to pedicle screw constructs, is challenging. Methods. Cochrane database, Ovid Medline, and PubMed were searched using the terms “pedicle screws” and “adolescent idiopathic scoliosis.” The reference list of the major papers by authors Lenke, Suk, and Kim were hand searched. Relevant articles were retained if they described a pedicle screw construct to correct AIS or compared pedicle screw constructs with another technique. Articles that did not have patients with adolescent idiopathic scoliosis in their subject groups or did not use pedicle screws as a part of their deformity correction were excluded from the study. Results. Based on the search strategy described above, 40 articles met the inclusion criteria and were selected for review in this manuscript. Of these, 32 studies are retrospective reviews including 2 studies that do not define their data collection technique. Six studies have a prospective study design, 1 is a case report, and 1 is a cadaveric study. Conclusion. In the absence of evidence from randomized trials, surgeons must rely on the best available information to guide patient management decisions. Although there have been many publications on the topic of all pedicle screw constructs in AIS, evidence regarding the advantage of all pedicle screw constructs remain limited to case series, biomechanical studies, and expert opinions.