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Surgical Outcomes Research

Anterior Release and Fusion in Pediatric Spinal Deformity: A Comparison of Early Outcome and Cost of Thoracoscopic and Open Thoracotomy Approaches

Newton, Peter O. MD; Wenger, Dennis R. MD; Mubarak, Scott J. MD; Meyer, R. Scott MD

Study Design: A consecutive series of patients undergoing thoracoscopic anterior spinal release and fusion for scoliosis or kyphosis was compared with a consecutive series of patients treated with an open thoracotomy approach.

Objectives: To compare the early clinical results, costs, and charges of performing an anterior thoracic spinal release and fusion with the two approaches.

Summary of Background Data: The thoracoscopic approach to the spine is gaining acceptance, yet there are little data comparing the technique with standard open methods for the treatment of spinal deformity.

Methods: The first 14 thoracoscopic cases performed at the authors’ hospital were compared with 18 open thoracotomy cases treated during the previous 12-month period. In each case the discs were excised and bone grafted before performing a posterior fusion. The early clinical outcomes and the hospital charges/costs were analyzed.

Results: The percent curve correction was similar between the thoracoscopic and open methods: scoliosis 56% and 60%, respectively; kyphosis, 88% and 94%, respectively. The blood loss and complication rates were similar between the two groups; however, the chest tube output was greater in the thoracoscopic group. The length of hospital stay was not reduced, and the cost of the open procedure is 29% less than the thoracoscopic approach. The minimally invasive thoracoscopic approach avoids cutting the chest/shoulder musculature, greatly decreasing the morbidity of anterior spinal surgery.

Conclusions: The thoracoscopic technique is a safe and effective alternative to open thoracotomy in the approach to the anterior thoracic spine for the treatment of pediatric and adolescent spinal deformity.

 

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Spine: 15 June 1997 – Volume 22 – Issue 12 – p 1398–1406