Exclude the cases with severe curves who require anterior release. In the 80's Zielke's VDS and modifications gained on popularity. What is the situation today? What does the ratio anterior/posterior look like.
We still do anterior instrumented fusions for Lenke type V curves at The Royal National Orthopaedic Hospital, Stanmore, London. The main reason is to derotate and translate the lumbar spine better. As a result, the anterior instrumented fusion usually allows fixation to L3 rather than L4. We are respectful of the patients with a high pelvic incidence and insert interbody support to attain enough lordosis.
As a visting research fellow at Queen Mary University hospital i Hong Kong I had a chance to see a few anterior fusions of Lenke V curves. In Copenhagen we do posterior fusion only for all curves. I think the amount of correction and translation is comparable but I am certain that you save fusion levels with the anterior approach. These curves are so rare that proper research results are hard to obtain.
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