A Comparative Study Between Thoracoscopic Surgery and Posterior Surgery Using All-pedicle-screw Constructs in the Treatment of Adolescent Idiopathic Scoliosis

Abstract

Despite its advantages, thoracoscopic surgery is losing its place in the surgical correction of AIS because of the frequent perioperative pulmonary complications and fixation problems compared with posterior pedicle screw fixation. Nevertheless, it can be utilized in selected cases particularly in cases of patient's strong demand for minimally invasive surgery.

Minimally Invasive Surgery for Adolescent Idiopathic Scoliosis: Anterior and Posterior Techniques

“…Advantages include decreased blood loss and transfusion rate, reduced total incision length, fewer fused levels, and preservation of approximately one distal level. Disadvantages include prolonged operative time, the need for a chest tube postoperatively and TLSO brace during 3 months, and slightly lesser improvement of pulmonary function [9,41,43].…”

“…Complications of TASF are primarily due to instrumentation failure (rod breakage), pseudarthrosis and pulmonary issues. Interestingly, deep wound infections are virtually non-existent after TASF, contrary to posterior fusion [9,30,32,37,41,[43][44][45][46][47][48][49].…”

“…However, due to an increased degree of correction and lower risk of instrumentation failure associated with the modern posterior technique, most spine surgeons, including the proponents of this technique, have converted almost entirely to the posterior approach for thoracic AIS. Those still using TASF generally restrict it to patients with specific concerns regarding the appearance of a long posterior midline scar, and who would accept wearing a postoperative brace [43,44]. Hence a posterior MIS technique, with a wider range of indications and simplified instrumentation, could be more largely accepted by spine surgeons.…”

Minimally invasive surgery in the treatment of adolescent idiopathic scoliosis: A literature review and meta-analysis

“…, 10 however, this study was discarded at the full text screen because there was no control. We assessed statistical heterogeneity by carrying out a chi-squared test, in order to determine whether the any observed differences between the studies could be explained by recourse to chance alone.…”

Early operative morbidity in 184 cases of anterior vertebral body tethering

“…Minimally invasive anterior alternatives include an anterior thoracoscopic approach and a thoracoscopically-assisted-mini-open approach 14 . The use of thoracoscopic procedures, however, is infrequent in part due to a steep learning curve 15 , 16 and greater incidence of complications 15 , 17 , 18 . Thus, the current surgical gold standard remains PSF 19 .…”