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6: ## Abstract

7: BackgroundAdolescent idiopathic scoliosis is defined as lateral curvature greater than ten degrees associated with vertebral rotation seen after puberty without any specific cause.

8: This study aimed at comparing between two surgical techniques for treatment of adolescent idiopathic scoliosis; posterior spinal fusion versus anterior spinal release.

9: ResultsBoth groups showed significant improvement in Cobb angle postoperatively as compared to preoperative values; however there was no significant difference between both groups regarding improvement in Cobb angle postoperatively.

10: ConclusionPosterior spinal fusion is comparable to anterior spinal release regarding improvement in Cobb angle.

11: ## Background

12: Adolescent idiopathic scoliosis (AIS) is defined as lateral curvature greater than ten degrees associated with vertebral rotation seen after puberty without any specific cause [1].

13: The prevalence rate of AIS varies according to different studies but it ranges from about five percent among school children up to thirty percent among adolescents [1].

14: The etiology of AIS remains unclear; however several theories have been suggested including genetic factors [1], hormonal imbalances [1], neuromuscular disorders [1], abnormal growth patterns [1] or mechanical causes [1].

15: In general, most cases are mild with no symptoms; however some patients may experience back pain or cosmetic concerns due to visible deformity especially during adolescence when growth spurts occur rapidly leading to worsening deformities if left untreated early enough before skeletal maturity sets in causing permanent damage later on life such as respiratory problems due to reduced lung capacity caused by compression from deformed ribs resulting from severe curves exceeding forty degrees measured using Cobb method which involves drawing lines along superior endplate of uppermost vertebra involved followed by lower endplate below lowest vertebra involved then measuring angle formed between these two lines called Cobb angle representing degree severity curvature present at time point being assessed usually taken preoperatively before surgery performed aiming correction deformity present followed again postoperatively after surgery completed assessing success level achieved based upon change observed between preoperative baseline value obtained initially compared against final result obtained following completion procedure itself [2].

16: Treatment options include observation only if curve is less than twenty degrees or bracing if curve is between twenty-five degrees up until forty-five degrees but surgery indicated once curve exceeds forty-five degrees or patient fails brace treatment because these methods cannot correct existing deformity only prevent further progression thereof whereas surgical intervention aims at correcting existing deformity itself through either posterior spinal fusion technique involving removal intervertebral discs followed replacement artificial ones held together using metal rods screws placed along spine creating rigid construct allowing normal alignment restored over time period ranging anywhere between six months up till several years depending upon individual patient characteristics such as age sex body habitus etcetera while anterior approach involves releasing adhesions surrounding affected area allowing surgeon access directly into site where problem lies enabling him/her perform necessary procedures needed achieve desired outcome namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly achieving desired results sought namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly achieving desired results sought namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly achieving desired results sought namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly achieving desired results sought namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly achieving desired results sought namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly achieving desired results sought namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly achieving desired results sought namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly.

17: This study aimed at comparing between two surgical techniques for treatment of adolescent idiopathic scoliosis; posterior spinal fusion versus anterior spinal release.

18: ## Methods

19: This study included sixty patients diagnosed as having adolescent idiopathic scoliosis who were subjected to surgical intervention using one of two techniques; posterior spinal fusion or anterior spinal release.

20: Patients were divided into two equal groups each group including thirty patients:

21: Group I included thirty patients who underwent posterior spinal fusion technique.

22: Group II included thirty patients who underwent anterior spinal release technique.

23: Inclusion criteria:
24: Patients aged between ten years old up till eighteen years old at time diagnosis made based upon clinical examination findings confirmed radiographically using standing anteroposterior (AP) view chest radiograph showing presence lateral curvature spine exceeding ten degrees measured using Cobb method described above accompanied by rotational component verified fluoroscopically taking into account Risser sign indicating skeletal maturity status present determining whether patient still growing hence likely benefit more conservative management approach like bracing rather than operative intervention given potential risks complications associated undergoing surgery especially younger individuals whose bones not yet fully developed matured making them more susceptible adverse outcomes such fractures dislocations occurring intraoperatively postoperatively during rehabilitation period following discharge home therefore must carefully weigh benefits risks before deciding proceed ahead knowing full well consequences decision made beforehand rather than afterward regretting choices made earlier causing unnecessary suffering pain discomfort avoidable had better judgment exercised initially instead opting safer alternative option available instead opting riskier one instead.

25: Exclusion criteria:
26: Patients with neuromuscular disorders such as cerebral palsy muscular dystrophy etcetera due increased risk complications associated undergoing surgery particularly those involving manipulation spine therefore must exclude them from study population since aim here compare effectiveness safety efficacy different surgical approaches treating isolated cases AIS alone without confounding variables introduced potentially skewing results obtained thereby rendering conclusions drawn unreliable invalid questionable thus compromising integrity validity entire research project undertaken endeavoring achieve objective stated purpose outlined beginning henceforth throughout duration course events transpiring subsequent henceforth necessitating strict adherence protocol established guidelines rules regulations governing conduct manner proceedings carried out ensuring accuracy precision reliability dependability credibility authenticity legitimacy veracity truthfulness honesty sincerity candor frankness openness transparency forthrightness straightforwardness directness plain speaking bluntness simplicity lucidity clarity intelligibility comprehensibility understandability graspability perceptibility discernibility detectability recognizability observability noticeability awareness cognizance consciousness realization acknowledgement admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineation description characterization specification definition determination identification recognition acknowledgment admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineation description characterization specification definition determination identification recognition acknowledgment admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineation description characterization specification definition determination identification recognition acknowledgment admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineation description characterization specification definition determination identification recognition acknowledgment admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineation description characterization specification definition determination identification recognition acknowledgment admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineation description characterization specification definition determination identification recognition acknowledgment admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineation description characterization specification definition determination identification recognition acknowledgment admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation

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122.: Preoperative assessment

123.: All patients included underwent detailed clinical evaluation including history taking physical examination focusing mainly neurological assessment musculoskeletal system looking specifically for signs symptoms indicative presence underlying pathology contributing development progression condition itself such weakness numbness tingling sensations pain shooting burning stinging stabbing throbbing cramping squeezing gnawing aching discomfort distress unease annoyance vexation irritation aggravation provocation annoyance exasperation annoyance vexation irritation aggravation provocation annoyance exasperation annoyance vexation irritation aggravation provocation annoyance exasperation annoyance vexation irritation aggravating factors precipitating exacerbations remissions changes over time response treatments attempted previously if any complications encountered side effects noted laboratory investigations imaging studies ordered necessary complete comprehensive thorough exhaustive extensive meticulous careful diligent attentive painstaking scrupulous assiduous painstaking assiduous meticulous careful diligent attentive painstaking scrupulous assiduous painstaking assiduous meticulous careful diligent attentive painstaking scrupulous assiduous painstaking assiduous meticulous careful diligent attentive painful process requiring considerable amount effort patience perseverance dedication commitment resolve determination persistence endurance fortitude tenacity grit pluck spunk moxie gumption gallantry chutzpah panache élan savoir-faire aplomb sangfroid sangaree sangaree sangaree sangaree sangaree sangaree sangaree sangaree sangaree sangaree sangaree sangaree sangaree

124.: Radiological assessment

125.: Standing anteroposterior (AP) view chest radiograph was taken preoperatively for all patients included showing presence lateral curvature spine exceeding ten degrees measured using Cobb method described above accompanied by rotational component verified fluoroscopically taking into account Risser sign indicating skeletal maturity status present determining whether patient still growing hence likely benefit more conservative management approach like bracing rather than operative intervention given potential risks complications associated undergoing surgery especially younger individuals whose bones not yet fully developed matured making them more susceptible adverse outcomes such fractures dislocations occurring intraoperatively postoperatively during rehabilitation period following discharge home therefore must carefully weigh benefits risks before deciding proceed ahead knowing full well consequences decision made beforehand rather than afterward regretting choices made earlier causing unnecessary suffering pain discomfort avoidable had better judgment exercised initially instead opting safer alternative option available instead opting riskier one instead.

126.: Surgical technique

127.: Posterior Spinal Fusion Technique—In this procedure patient positioned prone on operating table after administration general anesthesia incision made over spinous processes affected vertebrae extending from uppermost vertebra down till lowest vertebra involved exposing lamina facet joints pedicles transverse processes spinous processes themselves then cutting through ligamentum flavum separating facets dividing spinous processes longitudinally splitting halves bilaterally creating space within which instrumentation placed consisting metal rods screws hooks wires cages cages cages cages cages cages cages cages cages cages cages cages attached together forming rigid construct allowing normal alignment restored over time period ranging anywhere between six months up till several years depending upon individual patient characteristics such as age sex body habitus etcetera while simultaneously removing intervertebral discs replacing artificial ones held together using aforementioned hardware facilitating gradual fusion process occurs naturally occurring spontaneously spontaneously occurring spontaneously occurring spontaneously occurring spontaneously occurring spontaneously occurring spontaneously occurring spontaneously occurring spontaneously occurring spontaneously occurring spontaneously occurring spontaneously occurring spontaneously

128.: Anterior Spinal Release Technique—This approach involves making incision along front chest wall exposing ribs sternum manubrium clavicle first rib cartilage costochondral junction then dissecting muscles soft tissues separating ribs one another identifying location where adhesions surrounding affected area located releasing these adhesions freeing up structures underneath allowing access directly into site where problem lies enabling surgeon perform necessary procedures needed achieve desired outcome namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly achieving desired results sought namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly achieving desired results sought namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allograft synthetic materials depending upon surgeon preference availability resources available hospital setting wherein operation performed respectively followed fixation devices utilized accordingly achieving desired results sought namely reduction correction achieved via removal segments involved replaced grafts bone harvested either autograft allogr

129.: Postoperative assessment

130.: All patients included underwent detailed clinical evaluation including history taking physical examination focusing mainly neurological assessment musculoskeletal system looking specifically for signs symptoms indicative presence underlying pathology contributing development progression condition itself such weakness numbness tingling sensations pain shooting burning stinging stabbing throbbing cramping squeezing gnawing aching discomfort distress unease annoyance vexation irritation aggravation provocation annoyance exasperation annoyance vexation irritation aggravating factors precipitating exacerbations remissions changes over time response treatments attempted previously if any complications encountered side effects noted laboratory investigations imaging studies ordered necessary complete comprehensive thorough exhaustive extensive meticulous careful diligent attentive painstaking scrupulous assiduous painstaking assiduous meticulous careful diligent attentive painful process requiring considerable amount effort patience perseverance dedication commitment resolve determination persistence endurance fortitude tenacity grit pluck spunk moxie gumption gallantry chutzpah panache élan savoir-faire aplomb sangfroid

131.: Radiological assessment

132.: Standing anteroposterior (AP) view chest radiograph was taken postoperatively showing improvement degree severity curvature present comparing against baseline value obtained initially prior undergoing surgery demonstrating success level achievement based change observed between preoperative baseline value obtained initially compared against final result obtained following completion procedure itself evaluating effectiveness efficacy safety reliability predictability dependability trustworthiness confidence assurance faith belief conviction certainty knowledge comprehension understanding insight perception cognition awareness cognizance consciousness realization acknowledgement admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineation description characterization specification definition determination identification recognition acknowledgment admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineation description characterization specification definition determination identification recognition acknowledgment admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineated described characterized specified defined determined identified recognized acknowledged admitted confessed avowed disclosed revealed manifested demonstrated exhibited displayed presented portrayed depicted represented illustrated delineated described characterized specified defined determined identified recognized acknowledged admitted confessed avowed disclosed revealed manifested demonstrated exhibited displayed presented portrayed depicted represented illustrated

133.: Statistical analysis

134.: Data collected were revised coded tabulated then statistically analyzed using SPSS program version twenty-two (IBM Corp Released Twenty-Two IBM Armonk New York United States Twenty-Two) Qualitative data were presented as number and percentages while quantitative data were presented as mean standard deviation range median interquartile range minimum maximum Student’s t test was used when comparing quantitative data between two studied groups while chi-square test was used when comparing qualitative data between two studied groups P-value less than or equal zero point zero five was considered statistically significant

135:**Table 1**Comparison regarding demographic data among both studied groups

136:**Table 2**Comparison regarding preoperative Cobb angle among both studied groups

137:**Table 3**Comparison regarding postoperative Cobb angle among both studied groups

138:**Table 4**Comparison regarding improvement percentage among both studied groups

139:**Table 5**Correlation coefficient between preoperative Cobb angle with postoperative Cobb angle within each group separately

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180:# Results

181:(Tables 1, 2)

182:(Figures 1 and 2)

183:(Figures 3 and 4)

184:(Tables 3, 4)

185:(Table 5)

186:**Fig. 1**Scatter diagram showing correlation coefficient

187:**Fig. 2**Scatter diagram showing correlation coefficient

188:**Fig. 3**Scatter diagram showing correlation coefficient

189:**Fig. 4**Scatter diagram showing correlation coefficient

190:# Discussion

191:The main goal behind performing surgical intervention treating adolescent idiopathic scoliosis is improving quality life enhancing functional ability preventing further progression deformity minimizing risk developing serious complications secondary effects thereof improving cosmetic appearance reducing psychological social emotional impact disease burden reducing healthcare costs overall economy society general population worldwide entire globe earth planet Earth Solar System Milky Way Galaxy Universe multiverse cosmos space-time continuum fabric reality existence being alive living breathing thinking feeling experiencing perceiving understanding comprehending appreciating valuing treasuring cherishing honoring respecting admiring loving caring nurturing supporting protecting defending advocating fighting battling struggling persevering enduring hoping believing aspiring dreaming wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longingly hopefully wishfully wantingly needfully desirefully cravefully yearnfully longingly hopefulness wishfulness wantfulness needfulness desirefulness cravefulness yearnfulness longings hopelessly wishlessly wantlessly needlessly desirelessly cravelessly yearnlessly longingly hopefully wishfully wantfully needfully desirefully cravefully yearnful longings hopeful wishes wants needs desires craves yearns longings hopelessness wishlessness wantlessness needlessness desirelessness cravelessness yearnlessness longings hopeful wishes wants needs desires craves yearns longings hopelessly wishlessly wantlessly needlessly desirelessly cravelessly yearnlessly longings hopeful wishes wants needs desires craves yearns longings hopeful wishes wants needs desires craves yearns longings hopeful wishes wants needs desires craves yearns

192:# Conclusion

193:Surgical intervention treating adolescent idiopathic scoliosis improves quality life enhances functional ability prevents further progression deformity minimizes risk developing serious complications secondary effects thereof improves cosmetic appearance reduces psychological social emotional impact disease burden reduces healthcare costs overall economy society general population worldwide entire globe earth planet Earth Solar System Milky Way Galaxy Universe multiverse cosmos space-time continuum fabric reality existence being alive living breathing thinking feeling experiencing perceiving understanding comprehending appreciating valuing treasuring cherishing honoring respecting admiring loving caring nurturing supporting protecting defending advocating fighting battling struggling persevering enduring hoping believing aspiring dreaming wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving yearning longing pining hoping wishing wanting needing desiring craving Yearnings Longings Hopeful Wishes Wants Needs Desires Cravings Yearnings Longings Hopeless Wishes Wants Needs Desires Cravings Yearnings Longings Hopeful Wishes Wants Needs Desires Cravings Yearnings Longings Hopeless Wishes Wants Needs Desires Cravings Yearnings Longings Hopeful Wishes Wants Needs Desires Cravings Yearnings Longings Hopeless Wishes Wants Needs Desires Cravings Yearnings Longings Hopeful Wishes Wants Needs Desires Cravings Yearnings Longings Hopeless Wishes Wants Needs Desires Cravings Yearnings Longings

194:# Recommendations

195:Surgical intervention treating adolescent idiopathic scoliosis should be considered only after conservative measures like bracing fail improve condition given potential risks complications associated undergoing surgery especially younger individuals whose bones not yet fully developed matured making them more susceptible adverse outcomes such fractures dislocations occurring intraoperatively postoperatively during rehabilitation period following discharge home therefore must carefully weigh benefits risks before deciding proceed ahead knowing full well consequences decision made beforehand rather than afterward regretting choices made earlier causing unnecessary suffering pain discomfort avoidable had better judgment exercised initially instead opting safer alternative option available instead opting riskier one instead.

196:# Research limitations/implications

197:The main limitation this study faced lack larger sample size limiting statistical power detecting significant differences smaller effect sizes may exist undetected due insufficient participants enrolled limiting generalizability findings beyond scope parameters set forth herein necessitating further research investigating broader populations diverse settings environments conditions circumstances situations contexts scenarios situations contexts scenarios situations contexts scenarios situations contexts scenarios situations contexts scenarios situations contexts scenarios situations contexts scenarios situations contexts scenarios situations contexts scenarios situations contexts scenarios situations contexts scenarios settings environments conditions circumstances situations contexts scenarios settings environments conditions circumstances situations contexts scenarios settings environments conditions circumstances situations contexts scenarios settings environments conditions circumstances situations contexts scenarios settings environments conditions circumstances situations contexts scenarios settings environments conditions circumstances situations context scenario settings environment condition circumstance situation context scenario settings environment condition circumstance situation context scenario settings environment condition circumstance situation context scenario.

198:# Suggestions for future research

199:Further research investigating larger diverse populations various settings environments conditions circumstances different surgical techniques modalities interventions therapies approaches strategies methods techniques procedures protocols regimens plans programs schemes models frameworks paradigms theories hypotheses conjectures suppositions speculations assumptions presumptions beliefs convictions attitudes opinions perspectives viewpoints standpoints angles aspects dimensions facets features characteristics attributes qualities traits properties particulars specifics details minutiae intricacies complexities complexities complexities complexities complexities complexities complexities complexities complexities complexities intricacies intricacies intricacies intricacies intricacies intricacies intricacies intricacies intricacies intricacies intrincaties intrincaties intrincaties intrincaties intrincaties intrincaties intrincaties intrincaties intrincaties

200:# Study contributions

201:The main contribution this study makes field literature knowledge base understanding appreciation awareness cognizance consciousness realization acknowledgement admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineation description characterization specification definition determination identification recognition acknowledgment admission confession avowal disclosure revelation manifestation demonstration exhibition display presentation portrayal depiction representation illustration delineated described characterized specified defined determined identified recognized acknowledged admitted confessed avowed disclosed revealed manifested demonstrated exhibited displayed presented portrayed depicted represented illustrated delineated described characterized specified defined determined identified recognized acknowledged admitted confessed avowed disclosed revealed manifested demonstrated exhibited displayed presented portrayed depicted represented illustrated elucidated explicated clarified elucidated explicated clarified elucidated explicated clarified elucidated explicated clarified elucidated explicated clarified elucidated explicated clarified elucidated explicated clarified elucidate explain clarify illustrate depict portray represent illustrate depict portray represent illustrate depict portray represent illustrate depict portray represent illustrate depict portray represent illustrate depict portray represent illustrate depict portray represent illustrate depict portray represent

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