Anterior versus posterior approach in 3D correction of adolescent idiopathic thoracic scoliosis: a meta-analysis.

PURPOSE: Systematic review was conducted to compare effectiveness and safety of anterior and posterior surgical approach in 3D correction of adolescent idiopathic thoracic scoliosis. METHODS: Data sources were MEDLINE and SCOPUS databases. We included studies on the use of either anterior or posterior instrumentation, or their combination, in surgical correction of adolescent idiopathic thoracic scoliosis, with at least 10 enrolled patients, aged less than 20 years at the time of surgery, and a follow-up of at least 24 months. A study was eligible if it reported the number of patients, mean estimate and dispersion of three key outcome measures (frontal and sagittal Cobb angle, apical vertebra rotation according to Perdriolle) at three measurement points (preoperatively, postoperatively, at follow-up). The quality of studies was assessed using the scale by Pilkington. RESULTS: Although 24 articles met the inclusion criteria, no randomized controlled trials (RCT) was identified. None of the articles was of high quality. Both instrumentations provided a similar degree of reduction of frontal Cobb angle. Long-term effects of surgical correction on the sagittal Cobb angle seemed to be more stable in patients treated by posterior approach, while the anterior approach was more effective in the reduction of apical vertebral rotation. The surgery parameters were more favorable for anterior approach, particularly for the number of fused vertebrae. CONCLUSIONS: Although the available evidence favors neither of the two approaches, our study revealed several important issues: the reports are heterogeneous and provide incomplete relevant information. High quality studies, particularly RCT, are called for. LEVEL OF EVIDENCE: Level II.

Trace metals in the coastal soils developed from estuarine floodplain sediments in the Croatian Mediterranean region.

Fertile soils in the River Neretva estuary were developed by fluvial sedimentation and deposition of the eroded soil material from the karst hills within the catchment. After extensive reclamation, two reclaimed land zones (fluvial terraces and lower-laying terraces) have been delineated, both used for agriculture. The main objectives of this study were to evaluate soil chemical and geochemical properties in reclaimed zones that differ mainly in topography, soil types and agricultural land use. The origin of the trace metals in the arable soils was studied using multivariate statistics, and interpolation maps of trace metals were produced using GIS and geostatistics. Soil trace metal concentrations do not exceed a threshold value established by the Croatian Government regulation, with exception of copper. Comparative analysis of the main soil properties and trace metal concentrations in the study area showed a pronounced spatial variation and differences between two reclaimed zones in soil organic matter content, bioavailable P and total concentrations of Cd and Cu. Factor analysis in the area of the lower-laying terraces showed grouping of bioavailable P and K, organic matter content and pH (negative loading) in the component associated mostly with the land use. In the area of the fluvial terraces, bioavailable P and total Cd were grouped in the same component that may be explained by the traditional small farm agriculture and overuse of mineral fertilizers. In the whole study area, processes of secondary salinization were determined, accompanied by the raised chloride and sodium concentration measured in the saturation soil extract.