Newton, Peter O. MD; Parent, Stefan MD, PhD; Marks, Michelle MA, PT; Pawelek, Jeff BS
Study Design. Prospective, consecutive, single-surgeon case series of patients treated for scoliosis with thoracoscopic anterior spinal instrumentation.
Background. A thoracoscopic approach for insertion of anterior instrumentation has been developed in the past 10 years, which obviates many of the disadvantages of the open anterior thoracic approach. The morbidity associated with a thoracoscopy is limited because of the minimal skin and chest wall dissection required with this method.
Purpose. The purpose of this evaluation is to report a single surgeon’s experience with an initial series of 50 patients. The goal is to report the outcomes with regards to the radiographic findings, pulmonary function, and the SRS Outcomes Instrument, as well as a review of the perioperative data and complications.
Methods. The primary author’s initial 50 thoracoscopic anterior spinal instrumentation patients were consecutively collected. Data collection included demographics, such as age, gender, and diagnosis. Data regarding the surgical procedure included the operative time, intraoperative estimated blood loss, as well as the number of levels instrumented anteriorly. In the perioperative hospital period, data were collected with regard to the length of the hospital stay, the number of days in the ICU, the number of days of ventilator support, and the number of days after surgery when conversion from IV to PO pain medication occurred. Radiographic data were obtained systematically on each patient and measured by authors other than the surgeon. The SRS 22 and/or 24 Outcomes Questionnaire and pulmonary function tests were administered to patients at similar intervals.
Results. The series consisted of 44 females and 6 males with a mean age of 14 years (range, 9–48 years). Forty-five of the 50 patients were available for clinical and radiographic evaluation at greater than or equal to 2 years after surgery. The average length of follow-up for these 45 patients was 33 months (range, 2–5 years). The mean operative time for the procedure was 350 ± 50 minutes and ranged from 265 to 528 minutes. The estimated intraoperative blood loss averaged 431 ± 273 mL (range, 75–1,400 mL). Normalizing the operative time and estimated blood loss based on the number of levels treated resulted in an average operative time per level of 48 ± 6 minutes per level and an estimated intraoperative blood loss per level of 60 ± 37 mL per level. The preoperative thoracic Cobb averaged 53° ± 9° (range, 40°–80°). At most recent follow-up (≥2 years), the thoracic Cobb averaged 24° ± 7°. Implant failure occurred in 3 cases.
Conclusion. Thoracoscopic anterior instrumentation for adolescent idiopathic scoliosis is a viable surgical option. The outcomes of this consecutive series of patients is comparable to prior open and endoscopic series presented in the literature. The technical challenges of this operation are evident in the learning curve effect, which has been demonstrated.
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Spine: 1 September 2005 – Volume 30 – Issue 17S – pp S100-S109