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

Kishan, Shyam; Bastrom, Tracey P.; Betz, Randal R.; Lenke, Lawrence G.; Lowe, Thomas G.; Clements, David H.; D’Andrea, Linda; Sucato, Daniel J.; Newton, Peter O.

doi:10.1097/01.brs.0000255025.78745.e6

Cited by 65 publications

(32 citation statements)

References 23 publications

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“…The length of spinal fusions was not described. Other authors also reported on reduction in pulmonary function at 2 year postsurgery after open thoracotomy approach [9,10]. Our results were not in agreement with them.…”

Section: Discussioncontrasting

confidence: 98%

“…Results of both have been reported in the literature [3][4][5][6]. One of the main concerns of the anterior instrumentation of thoracic spine is the possible compromise of pulmonary function [3,[7][8][9][10]. In the thoracoscopic method a complete disc removal, involving the complete removal of the posterior annulus, is technically impossible.…”

Section: Introductionmentioning

confidence: 99%

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Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical, radiological and pulmonary function results

et al. 2012

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Introduction This is a prospective study of adolescent patients in whom idiopathic thoracic scoliosis was corrected by short anterior fusion through a mini-open thoracotomy approach. Clinical, radiological and pulmonary function results of minimal 2-year (2-6) follow-up are presented. Materials and methods Consecutive 62 patients with Lenke 1 and 2 curves, having main thoracic scoliosis of up to 75°, were prospectively included. The shoulder imbalance in Lenke 2 patients was less than 20 mm. Thoracic scoliosis was corrected by short anterior fusion. The thoracic spine was exposed by an 8-cm mini-open thoracotomy incision. The operation technique and choosing of fusion levels are thoroughly described. Complete 360°discectomies and convex side vertebral endplates osteotomies are essential for deformity corrections with short fusions. Single-rod 5.5-mm titanium implants were used. The age at the time of operation was mean 15.2 years; 56 patients had a single thoracic curve and 6 patients had a double thoracic curve. There were almost equal numbers of patients with lumbar modifier A, B or C. The average length of fusion was 5.5 (4-7) vertebrae. The average length of fusion was 3.5 (2-6) vertebrae shorter than the average curve length. Results The instrumented thoracic curves improved by 58.3% at 6 weeks and 56.3% at the last follow-up. Apex thoracic vertebral rotation improved by 73.78% at 6 weeks and 76.24% at the last follow-up. The non-instrumented upper thoracic curve improved by 25% in double thoracic scoliosis, where the mid-thoracic curve was selectively fused, and the non-instrumented lumbar curves improved by 33.9% at the last follow-up. The radiological changes from 6 weeks to the last follow-up were statistically not significant. The clinical rib hump improved by 54% at the last follow-up. There were no significant changes in the pulmonary function. FVC% was 81.04% preoperatively, 76.41% at 6 months and 80.38% at the 2-year follow-up. The results of SRS 24 questionnaire improved from a total of 61.40 points preoperatively to 100.50 points at 6 months and 98.62 points at the 2-year follow-up. There were no neurological or thoracotomy related complications, no pseudarthrosis, no implant pullout or breakage. Conclusion A good deformity correction without loss of correction or adding on, a good cosmetic result and good patient's satisfaction were achieved through shorter than end-to-end thoracic fusions. The radiological residual deformity is acceptable. Anterior correction of thoracic scoliosis with a short spinal fusion is recommended to keep the large part of the spine mobile. A very short fusion, small thoracotomy incision, low-profile implants and complete closure of parietal pleura are keys to prevent reduction in postoperative lung function.

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Section: Discussioncontrasting

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical, radiological and pulmonary function results

et al. 2012

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“…36,37 Nevertheless, an anterior release and fusion can still provide an important option, particularly in smaller, younger patients or very severe magnitude curves. Given the improved pulmonary outcomes with VATS compared with thoracotomy, 10,37 an anterior approach in idiopathic scoliosis, which has fewer respiratory problems than the neuromuscular population, remains all the more reasonable.…”

Section: Resultsmentioning

confidence: 99%

Fusion Rates After Thoracoscopic Release and Bone Graft Substitutes in Idiopathic Scoliosis

Weinzapfel

Son-Hing

Armstrong

et al. 2008

Spine

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“…A decade of prior studies have reported on the outcomes of this minimally invasive technique. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Several advantages of thoracoscopic instrumentation over open scoliosis surgery using both anterior and posterior approaches have been reported in these studies, including improved cosmesis, less levels fused, reduced blood loss, decreased incidence of infection and neurologic complications, shorter hospitalization, reduced pain and chest wall morbidity, and faster recovery of pulmonary function.…”

mentioning

confidence: 99%

The Relationship Between Deformity Correction and Clinical Outcomes After Thoracoscopic Scoliosis Surgery

Izatt¹,

Adam²,

Labrom³

et al. 2010

Spine

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

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

Cited by 65 publications

References 23 publications

Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical, radiological and pulmonary function results

Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical, radiological and pulmonary function results

Fusion Rates After Thoracoscopic Release and Bone Graft Substitutes in Idiopathic Scoliosis

The Relationship Between Deformity Correction and Clinical Outcomes After Thoracoscopic Scoliosis Surgery

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