Video-Assisted Thoracoscopy for Vertebral Body Tethering of Juvenile and Adolescent Idiopathic Scoliosis: Tips and Tricks of Surgical Multidisciplinary Management

Abstract

VATS (video assisted thoracoscopic surgery) is routinely and successfully performed in minor and major complex thoracic procedures. This technique has been recently introduced for the treatment of severe forms of idiopathic scoliosis (IS) with the aim to repair the deformity, reduce morbidity and to prevent its progression in patients with skeletal immaturity. This study aims to present VATS in anterior vertebral body tethering (AVBT) approach to support the pediatric orthopedic surgeons during vertebral body fixation. Surgical and anesthesiologic tips and tricks are reported to assure a safe procedure. The study includes preadolescents with IS and a grade of scoliosis >40° that had a high probability of deterioration due to remaining growth (December 2018 to April 2021). Skeletal immaturity of enrolled patients was assessed by Sanders classification and Risser sign. Patients had a Risser score between 0 and 1 and a Sanders score >2 and <5. AVBT technique using VATS was performed by a senior pediatric surgeon assisting the pediatric orthopedic surgeon. Twenty-three patients have been submitted to VATS AVBT in the period of study (age range 9–14 years). The patients had a classified deformity Lenke 1A or B convex right and all types of curves were treated. In all patients, the vertebrae submitted to tethering surgery ranged from D5 to D12; mean curve correction was 43%. Three postoperative complications occurred: one late postoperative bleeding requiring a chest tube positioning on 12th postoperative day; one screw dislodged and needed to be removed; one child showed worsening of the scoliosis and needed a posterior arthrodesis. Initial results of VATS AVBT in growing patients with spinal deformities are encouraging. An appropriate selection of patients and a pediatric dedicated multidisciplinary surgical approach decrease intraoperative complications, time of operation and postoperative sequelae and guarantee an optimal outcome.

Cirurgia toracoscópica na abordagem da escoliose idiopática: Revisão sistemática de literatura

“…17,19,20 Crawford e Lenke 22 described the vertebral body tethering in 2010 resulting in growth modulation and progressive correction of the juvenile idiopathic scoliosis. Costanzo et al 23 indicated the video-assisted thoracoscopy for vertebral body tethering in pre-adolescents with a scoliosis degree above 40°. All patients presented scoliosis reduction and significant functional gains.…”

“…17,19,20 A amarração do corpo vertebral já havia sido descrita anteriormente em 2010 por Crawford e Lenke 22 resultando em uma modulação do crescimento e correção progressiva da escoliose idiopática juvenil. No estudo realizado por Costanzo et al 23 a videotoracoscopia é indicada para amarração do corpo vertebral em pré-adolescentes com grau de escoliose acima de 40°. Em todos os pacientes houve redução da escoliose com ganhos funcionais importantes.…”

Clinical experience and complications with limited pleural dissection combined with a novel, simplified technique for thoracic Redon-like drain in vertebral body tethering

“…As a routine, most authors use a chest drain after surgery to avoid pneumothorax and pleural effusion [ 15 ]. However, there is no consensus as to how long the drain is kept in place: some authors remove it when the output in 24 h is below 100 ml [ 7 ], while others wait until the output is below 20 ml [ 9 ]. This, of course, reflects on the time for which the drain stays in place, which has been reported to average 2–3 days but has been prolonged to up to 5 days [ 9 ].…”

“…With the improvement of medical devices and technical skill, the time of VBT procedures has drastically decreased [ 8 , 9 ]. However, there is still a degree of variability regarding the type of skin approach (mini open vs. thoracoscopic), pleural approach (one long incision vs. multiple small ones), and the type of used drain.…”

Multidisciplinary Management of Children with Occult Spinal Dysraphism: A Comprehensive Journey from Birth to Adulthood

“…In selected cases, when necessary, soft-tissue release, different types of osteotomies, or hemiepiphysiodesis for valgus are among the methods used to correct these abnormalities. Finally, severe forms of scoliosis can occur: when indicated, to repair the deformity, reduce morbidity, and prevent its progression in patients with skeletal immaturity, different surgical techniques can be employed according to the degree of scoliosis and the children’s age [ 22 ]. Physiotherapy was proposed post-surgically or when indicated during the child’s growth.…”