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Surgical Outcomes Research

Prospective Pulmonary Function Comparison of Open Versus Endoscopic Anterior Fusion Combined With Posterior Fusion in Adolescent Idiopathic Scoliosis

Lenke, Lawrence G. MD*; Newton, Peter O. MD†; Marks, Michelle C. PT, MA†; Blanke, Kathy M. RN*; Sides, Brenda MA†; Kim, Yongjung J. MD*; Bridwell, Keith H. MD*

Study Design. Prospective clinical study.

Objective. To evaluate pulmonary function tests at a minimum 2-year follow-up in patients with adolescent idiopathic scoliosis (AIS) undergoing either an endoscopic versus open anterior fusion along with posterior segmental fixation and fusion.

Methods. A total of 21 patients with AIS underwent a video-assisted thoracoscopic (VAT group) release/fusion followed by a posterior spinal fusion (PSF) and segmental spinal fixation were compared to 16 patients who underwent an open thoracotomy (Open group) followed by a PSF. The mean preoperative thoracic Cobb was 70° in the VAT group versus 75° in the Open group. All patients had preoperative and a minimum 2-year postoperative pulmonary function tests consisting of forced vital capacity (FVC) forced expiratory volume in one second (FEV-1).

Results. The average thoracic Cobb correction was to 27° (61%) in the VAT group versus 36° (52%) in the Open group. Preoperative and 2-year postoperative FVC in the VAT group averaged 2.48 L and 2.85 L, respectively (P = 0.006). The Open group corresponding results were 1.97 L and 2.43 L, respectively (P = 0.001). Preoperative and minimum 2-year postoperative FEV-1 in the VAT group averaged 2.06 L and 2.37 L, respectively (P = 0.005). Values for the Open group were 1.65 L and 2.08 L, respectively (P = 0.001). Although both groups had pulmonary function test parameters that were statistically improved postoperative versus preoperative, there were no significant differences comparing the VAT group to the Open group (P > 0.05)

Conclusions. VAT versus Open release/anterior fusion in association with a PSF for select AIS curves requiring circumferential treatment both demonstrated similar radiographic and pulmonary function test improvement at 2 years postoperative, with no significant differences seen between the groups.

 

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Spine: 15 September 2004 – Volume 29 – Issue 18 – pp 2055-2060