title: Prone position endoscopic transthoracic release with simultaneous posterior instrumentation for spinal deformity: a description of the technique.
abstract: METHODS
  A prospective series of 15 consecutive adult patients with spinal deformity who underwent endoscopic transthoracic release with simultaneous posterior instrumentation while positioned prone.
  
  
  OBJECTIVE
  To describe the technique and clinical results of endoscopic transthoracic release performed with the patient prone (as opposed to lateral) on the concave side for scoliosis or on either side for kyphosis, with simultaneous posterior exposure, instrumentation, and correction of the deformity.
  
  
  BACKGROUND
  Use of endoscopic surgical techniques is rapidly advancing across all subspecialties. These techniques can be used to expose and operate on the spine in a less invasive fashion, thus avoiding damage to other tissues and facilitating earlier mobilization and rehabilitation. Current endoscopic techniques with the patient in the lateral decubitus position mimic open thoracotomy. A new technique is described with the patient positioned prone, which allows simultaneous posterior exposure.
  
  
  METHODS
  Preoperative Cobb angle or thoracic kyphosis angle, maximal correction bending films, and postoperative Cobb angle or kyphosis angle were measured and compared. All perioperative morbidity, intraoperative complications, and surgical variables were prospectively documented and analyzed.
  
  
  RESULTS
  There were no intraoperative technical problems with the endoscopic equipment or instruments and no immediate, 6-month, or 2-year postoperative complications related to the endoscopic component of the procedure. In the scoliosis patients, the average correction was 60%. In the kyphosis patients, the average correction was 39%.
  
  
  CONCLUSIONS
  Transthoracic endoscopic techniques, compared with thoracotomy, offer a less invasive method of accessing the anterior spinal column, with the benefits of an excellent view of the area of the spine being instrumented, minimal soft tissue disruption, and an improved cosmetic result. With the simultaneous technique, staged or subsequent procedures can be eliminated, and a circumferential structural release as well as control of the mobilized spine can be achieved. This simultaneous technique can be extended for use in correction of a variety of thoracic spinal pathologies.
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: I H
authors.initials: IH
authors.lastname: Lieberman
authors.forename: P T
authors.initials: PT
authors.lastname: Salo
authors.forename: R D
authors.initials: RD
authors.lastname: Orr
authors.forename: B
authors.initials: B
authors.lastname: Kraetschmer
mesh_terms: D000293:Adolescent; D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators / Q000592:standards*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016684:Prone Position / Q000502:physiology; D011446:Prospective Studies; D020127:Recovery of Function; D013121:Spinal Curvatures / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome