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Surgical Outcomes Research

Anterior Endoscopic Discectomy and Fusion for Adolescent Idiopathic Scoliosis

Lenke, Lawrence G. MD

Study Design. A review of adolescent patients with idiopathic scoliosis undergoing endoscopic release and spinal fusion.

Objective. To describe the indications, techniques, results, and complications of thoracic anterior endoscopic scoliosis surgery.

Summary of Background Data. Anterior endoscopic treatment of thoracic adolescent idiopathic scoliosis has become an alternative method of surgical treatment.

Methods. Twenty-one patients with adolescent idiopathic scoliosis have undergone a thoracic anterior endoscopic release and fusion followed by posterior instrumentation and fusion. Indications for the endoscopic fusion were large curve magnitude, skeletal immaturity, and/or thoracic hyperkyphosis. Eleven patients have undergone anterior endoscopic instrumentation and fusion for thoracic scoliosis curves between 45° and 70°, using a single screw/single rod construct and autogenous rib bone graft.

Results. Results from the anterior endoscopic release and fusion procedures followed by a posterior instrumentation and fusion had an average preoperative curve of 82° (range, 41°–125°), with postoperative correction to 28° (range, 5°–60°) showing 70% correction.

For patients undergoing an anterior endoscopic instrumentation and fusion, the average preoperative Cobb measurement of 53° (range, 44°–62°) was corrected to an average 26° (range, 18°–38°) for an average correction rate of 51%. One patient undergoing an anterior endoscopic release was converted to an open procedure for end plate bony bleeding without sequelae. One patient with an anterior endoscopic instrumentation and fusion had revision anterior surgery for a distal set screw dislodgment and subsequent posterior instrumentation and fusion for pseudarthrosis.

Conclusions. The use of both anterior endoscopic release and fusion combined with either anterior instrumentation or separate posterior instrumentation and fusion continues to evolve. Surgeons treating patients with these techniques must understand that there are specific indications for them and many technique options available to optimize surgical results.

Although video assisted thoracoscopic techniques have been utilized for over 10 years now, 1–4 techniques involving the endoscopic approach, anterior discectomy and fusion, and instrumentation options continue to evolve. 5 It is therefore appropriate to evaluate the current state of the art of video assisted thoracoscopic (VAT) release, fusion, and instrumentation (VAT-I) as it relates to the surgical treatment of thoracic adolescent idiopathic scoliosis (AIS).

 

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Spine: 1 August 2003 – Volume 28 – Issue 15S – pp S36-S43

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