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Surgical Outcomes Research

Thoracoscopic Scoliosis Surgery Affects Pulmonary Function Less Than Thoracotomy at 2 Years Postsurgery

Kishan, Shyam MD*; Bastrom, Tracey MA*; Betz, Randal R. MD†; Lenke, Lawrence G. MD‡; Lowe, Thomas G. MD§; Clements, David MD¶; D’Andrea, Linda MD†; Sucato, Daniel J. MD∥; Newton, Peter O. MD*

Study Design. Prospective evaluation of pulmonary function before and 2 years after surgery following anterior scoliosis instrumentation.

Objectives. To determine if thoracoscopic anterior scoliosis correction with instrumentation affected pulmonary function less than open thoracotomy approaches at 2 years follow-up.

Summary of Background Data. The thoracoscopic approach has been shown to have a smaller reduction in pulmonary function tests (PFTs) compared with an open thoracotomy approach following anterior thoracic instrumentation for adolescent idiopathic scoliosis in the immediate postoperative period; however, it is unclear if a difference remains 2 years following the procedure.

Methods. A total of 107 patients in a multicenter adolescent idiopathic scoliosis database underwent an anterior instrumented fusion for thoracic scoliosis. PFTs assessing forced vital capacity (FVC), forced expiratory volume (FEV1), and total lung capacity (TLC) were obtained prospectively before and 2 years after surgery. The patients were grouped as follows: Group I, thoracoscopic instrumented fusion (n = 36); Group II, open (thoracotomy) instrumented fusion without thoracoplasty (n = 28); and Group III, open instrumented fusion with thoracoplasty (n = 43).

Results. Thoracoscopic instrumentation affected pulmonary function 2 years after surgery minimally, and on an average showed improvements in all parameters except the percent-predicted FVC, which decreased by 1% ± 11%, and percent predicted FEV, which decreased by 2% ± 9%. Improvements were noted in absolute FVC, FEV1, TLC, and percent-predicted TLC. This is in contrast to the patients treated with a thoracotomy, who had a greater persistent reduction in PFTs at follow-up. An added thoracoplasty to the thoracotomy approach, however, resulted in even greater residual reduction in PFTs at follow-up, with declines in percent-predicted FVC of 15%, percent-predicted FEV1 of 14%, and percent-predicted TLC of 8%.

Conclusions. This study shows a clear advantage to the minimally invasive thoracoscopic approach with regards to pulmonary function when compared with the open thoracotomy approaches.

 

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Spine: 15 February 2007 – Volume 32 – Issue 4 – pp 453-458

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