Thoracoscopic Spinal Fusion Compared with Posterior Spinal Fusion for the Treatment of Thoracic Adolescent Idiopathic Scoliosis: Surgical Technique

• Published in: Journal of bone and joint surgery. American volume 2007-03, Vol.89 (2_suppl_1 Suppl 1), p.142-156
• Main Authors: Lonner, Baron S, Kondrachov, Dimitry, Siddiqi, Farhan, Hayes, Victor, Scharf, Carrie
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Blood Loss, Surgical; Diseases of the osteoarticular system; Diseases of the spine; Humans; Intraoperative Complications; Medical sciences; Orthopedic surgery; Peak Expiratory Flow Rate; Radiography; Scoliosis - diagnostic imaging; Scoliosis - physiopathology; Scoliosis - surgery; Spinal Fusion - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thoracic Vertebrae; Thoracoscopy; Time Factors; Vital Capacity
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.F.01389

BACKGROUND:Posterior spinal fusion with segmental instrumentation is the gold standard for the surgical treatment of thoracic adolescent idiopathic scoliosis. More recently, anterior surgery and video-assisted thoracoscopic surgery with spinal instrumentation have become an option. The purpose of the present study was to compare the radiographic and clinical outcomes as well as pulmonary function in patients managed with either anterior thoracoscopic or posterior surgery.METHODS:Radiographic data, Scoliosis Research Society patient-based outcome questionnaires, pulmonary function, and operative records were reviewed for fifty-one patients undergoing surgical treatment of scoliosis. Data were collected preoperatively, immediately postoperatively, and at the time of the final follow-up. The radiographic parameters that were analyzed included coronal curve correction, the most caudad instrumented vertebra tilt angle correction, coronal balance, and thoracic kyphosis. The operative parameters that were evaluated included the operative time, the estimated blood loss, the blood transfusion rate, the number of levels fused, the type of bone graft used, and the number of intraoperative and postoperative complications. The pulmonary function parameters that were analyzed included vital capacity and peak flow.RESULTS:The thoracoscopic group included twenty-eight patients with a mean age of 14.6 years, and the posterior fusion group included twenty-three patients with a mean age of 14.3 years. The percent correction was 54.5% for the thoracoscopic group and 55.3% for the posterior group. With the numbers available, there were no significant differences between the two groups in terms of kyphosis (p = 0.84), coronal balance (p = 0.70), or tilt angle (p = 0.91) at the time of the final follow-up. The mean number of levels fused was 5.8 in the thoracoscopic group, compared with 9.3 levels in the posterior group (p < 0.0001). The estimated blood loss in the thoracoscopic group was significantly less than that in the posterior fusion group (361 mL compared with 545 mL; p = 0.03), and the transfusion rate in the thoracoscopic group was significantly lower than that in the posterior fusion group (14% compared with 43%; p = 0.01). Operative time in the thoracoscopic group was significantly greater than that in the posterior group (6.0 compared with 3.3 hours, p < 0.0001). There were no intraoperative complications in either group. Vital capacity and peak flow had returned to