Surgical Treatment of Main Thoracic Scoliosis with Thoracoscopic Anterior Instrumentation

Newton, Peter O.; Upasani, Vidyadhar V.; Lhamby, Juliano; Ugrinow, Valerie L.; Pawelek, Jeff B.; Bastrom, Tracey P.
October 2008
Journal of Bone & Joint Surgery, American Volume;Oct2008, Vol. 90-A Issue 10, p2077
Academic Journal
Background: The surgical outcomes in patients with scoliosis at two years following anterior thoracoscopic spinal instrumentation and fusion have been reported. The purpose of this study was to evaluate the results at five years. Methods: A consecutive series of forty-one patients with major thoracic scoliosis treated with anterior thoracoscopic spinal instrumentation was evaluated at regular intervals. Prospectively collected data included patient demographics, radiographic measurements, clinical deformity measures, pulmonary function, an assessment of intervertebral fusion, and the scores on the Scoliosis Research Society (SRS-24) outcomes instrument. Perioperative and postoperative complications were recorded. Patient data for the preoperative, two-year, and five-year postoperative time points were compared. In addition, a univariate analysis compared selected two-year radiographic, pulmonary function, and SRS-24 data of the study cohort and those of the patients lost to follow-up. Results: Twenty-five (61%) of the original forty-one patients had five-year follow-up data and were included in the analysis. Between the two-year and five-year follow-up visits, no significant changes were observed with regard to the average percent correction of the major Cobb angle (56% ± 11% and 52% ± 14%, respectively), average total lung capacity as a percent of the predicted value (95% ± 14% and 91% ± 10%), and the average total SRS-24 score (4.2 ± 0.4 and 4.1 ± 0.7). Radiographic evaluation of intervertebral fusion at five years revealed convincing evidence of a fusion with remodeling and trabeculae present at 151 (97%) of the 155 instrumented motion segments. No postoperative infections or clinically relevant neurovascular complications were observed. Rod failure occurred in three patients, and three patients required a surgical revision with posterior spinal instrumentation and fusion. Conclusions: Thoracoscopic anterior instrumentation for main thoracic idiopathic scoliosis results in five-year outcomes comparable with those reported previously for open anterior and posterior techniques. The radiographic findings, pulmonary function, and clinical measures remain stable between the two and five-year follow-up time points. Thoracoscopic instrumentation provides a viable alternative to treat spinal deformity; however, the risks of pseudarthrosis, hardware failure, and surgical revision should be considered along with the advantages of limited muscular dissection and improved scar appearance. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • spinal fusion.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p2174 

    A reference entry for the term "spinal fusion" is presented, which refers to the surgical immobilization of adjacent vertebrae. "

  • spinal fusion. Peters, Michael // BMA A-Z Family Medical Encyclopedia;2004, p707 

    An encyclopedia entry for "spinal fusion" is presented. It refers to a major surgery in which two or more adjacent vertebrae are joined together. The surgical procedure is performed if there is abnormal movement between adjacent vertebrae that causes severe back pain or risks damaging the spinal...

  • Correction maneuvers in scoliosis surgery - an overview. Theruvath, Ameer S.; Mahajan, Rajat; Gururaj M.; Chhabra H. S.; Tandon, Vikas; Nanda, Ankur // Kerala Journal of Orthopaedics; 

    Scoliosis surgery is one of the most challenging procedures in the surgical world. Many procedues are described for the correction of the spinal deformities. The authors review the different posterior surgical maneuvers used in correction of scoliosis. The methods like distraction-compression,...

  • Does Minimally Invasive Transsacral Fixation Provide Anterior Column Support in Adult Scoliosis? Anand, Neel; Baron, Eli; Khandehroo, Babak // Clinical Orthopaedics & Related Research;Jun2014, Vol. 472 Issue 6, p1769 

    Background: Spinal fusion to the sacrum, especially in the setting of deformity and long constructs, is associated with high complication and pseudarthrosis rates. Transsacral discectomy, fusion, and fixation is a minimally invasive spine surgery technique that provides very rigid fixation. To...

  • Selective thoracic fusion in AIS curves: the definition of target outcomes improves the prediction of spontaneous lumbar curve correction (SLCC). Koller, Heiko; Meier, Oliver; Albrecht, Heidrun; Schmidt, Rene; Zenner, Juliane; Hitzl, Wolfgang // European Spine Journal;Jun2014, Vol. 23 Issue 6, p1263 

    Introduction: The decision of when to use selective thoracic fusion (STF) and the prediction of spontaneous lumbar curve correction (SLCC) remain difficult. Using a novel methodological approach, the authors yielded for a better prediction of SLCC and analyzed the efficacy of anterior scoliosis...

  • Fusionless Surgery for Scoliosis. Hershman, Stuart H.; Park, Justin J.; Lonner, Baron S. // Bulletin of the Hospital for Joint Diseases;2013, Vol. 71 Issue 1, p49 

    Scoliosis is a very common condition, affecting approximately 7 million children in the United States. Treatment of this condition in young children can be challenging. A variety of techniques that avoid spinal fusion have been developed to manage scoliosis in this patient population. This...

  • Spinal fusion in children with spina bifida: influence on ambulation level and functional abilities. Schoenmakers, M.; Gulmans, V.; Gooskens, R.; Pruijs, J.; Helders, P. // European Spine Journal;Jun2005, Vol. 14 Issue 4, p415 

    The aim of this study was to determine the influence of spinal fusion on ambulation and functional abilities in children with spina bifida for whom early mobilization was stimulated. Ten children (three males and seven females) with myelomeningocele were prospectively followed. Their mean age at...

  • Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion. Rodríguez-Vela, J.; Lobo-Escolar, A.; Joven-Aliaga, E.; Herrera, A.; Vicente, J.; Suñén, E.; Loste, A.; Tabuenca, A. // European Spine Journal;Dec2009, Vol. 18 Issue 8, p1194 

    It has been widely reported a vascular and neurologic damage of the lumbar muscles produced in the classic posterior approach for lumbar spinal fusions. The purpose of this study is to demonstrate a better clinical and functional outcome in the postoperative and short term in patients undergoing...

  • Experimental investigation of the lumbar spine -- influence of destabilization on the stiffness characteristic. Szust, Agnieszka // Acta of Bioengineering & Biomechanics;2006, Vol. 8 Issue 2, p127 

    The lumbar spine region is most often affected by disorders. These disorders lead to instability in the motion segments. Many surgical procedures have been undertaken to reduce instability and restore the function of the spine. Spinal fusion is most commonly used to stabilise unstable motion...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics