We demonstrate a substantial difference in the position of the aorta relative to the spine in prone and in supine position, which is most markedly seen at levels T4 to T8. The aorta is positioned posterolateral to the spine in supine position and more anteromedial in prone position. Before performing anterior thoracolumbar spine surgery, we suggest to measure vertebral body width, as well as the position of the aorta in the prone and in the supine patient to decide if his approach is technically feasible, or if an alternative (contralateral) approach is preferable.
Screw placement in double-rod anterior spinal fusion in idiopathic scoliosis seems to be technically demanding, and the use of fluoroscopic control results in less frequent malposition. The risk of neurologic and vascular complications is low.
PurposeStandard thoracotomy for anterior instrumentation and fusion of the thoracic spine in idiopathic scoliosis may have detrimental effects on pulmonary function. In this study we describe a less invasive anterior surgical technique and show the pre- and postoperative pulmonary function with a minimum follow-up of 2 years.MethodsTwenty patients with Lenke type 1 adolescent thoracic idiopathic scoliosis were treated with anterior spinal fusion and instrumentation. The mean preoperative Cobb angle of the thoracic curve was 53° ± 5.8. Pulmonary function tests (PFT) and radiographic evaluation was performed.ResultsThe mean postoperative correction in Cobb angle of the thoracic curve was 27° ± 8.2 (49%).The mean preoperative FEV1 was 2.81 ± 0.43 L, which increased to 3.14 ± 0.50 L at 2 years postoperatively (P = 0.000). The mean FEV1% did not change (89.60 ± 7.49% preoperatively, versus 90.53 ± 5.95% at 2 years follow-up, P = 0.467). The TLC increased from 4.62 ± 0.62 L preoperatively to 5.17 ± 0.63 L at 2 years follow-up (P = 0.000). The FEV1% at two years of follow-up improved to 104% of the FEV1% predicted value. The FEV1 improved to 97% of the FEV1 predicted value.ConclusionAnterior spinal fusion for idiopathic scoliosis by means of a minimal open thoracotomy proved to be a safe surgical technique that resulted in an improvement of pulmonary function. Our results are similar to those of thoracoscopic procedures reported in literature.
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