Abstract
BACKGROUND: Correcting severe scoliosis is challenging due to curve rigidity and risks to cardiopulmonary and neurologic function. Osteotomy techniques offer greater correction but carry higher complication rates, while non-osteotomy methods may be safer but less effective. This systematic review compares outcomes between osteotomy and non-osteotomy approaches in treating severe idiopathic scoliosis. METHODS: A systematic search was conducted in PubMed, EMBASE, and the Cochrane Library using MeSH terms related to "idiopathic adolescent scoliosis", "AIS", "severe scoliosis", and "surgical outcome". The review followed PRISMA guidelines. RESULTS: An initial search yielded 565 studies, of which 23 studies (n = 932 patients) met the inclusion criteria. The Vertebral Column Resection (VCR) group achieved the greatest spinal correction, with a mean Cobb angle of 106.7 ± 9.7° and a correction rate of 62.1%, but also had the highest complication rate at 24%. Non-osteotomy methods provided similar correction (107.0 ± 9.1°, 61.5%) with a slightly lower complication rate of 19.6%. The Ponte osteotomy group had the lowest complication rate (4%) with a moderate level of correction (107.4 ± 10.5°, 60.3%). In terms of functional outcomes, the non-osteotomy group reported the highest SRS-22r scores, averaging 4.3. CONCLUSION: VCR offers the most significant curve correction, but with a higher complication rate. Ponte osteotomy provides a safer alternative with acceptable clinical outcomes. In contrast, non-osteotomy techniques strike a balance between correction and risk, with favorable functional results.