Thoracoscopic approach for spine deformities.
BACKGROUND
We reviewed our experience using anterior thoracoscopic procedures in the correction of severe idiopathic scoliosis and kyphotic deformities to evaluate the feasibility and effectiveness of such procedures.


METHODS
Twenty-four patients who underwent thoracoscopic surgical correction of the spine between March 1995 and December 2001 were retrospectively reviewed. A team consisting of one orthopaedic surgeon and one thoracic surgeon performed anterior thoracoscopic soft tissue release, disc excision, and bone grafting followed on the same day with posterior instrumentation and correction of deformity.


RESULTS
There were 16 female and 8 male patients, with a median age of 16 years (range 11 to 47 years) with idiopathic scoliosis (20 patients) or kyphotic deformity (4 patients). The average time for the thoracoscopy was 125 minutes (range 60 to 175 minutes). Blood loss averaged 135 mL (range 20 to 350 mL), and a median number of five discs (range two to eight) were excised. The median ICU time was 2 days (range 1 to 8 days), and the median length of hospital stay was 6 days (range 4 to 11 days). One patient required conversion to an open procedure because of arterial bleeding from the cancellous bone (T5). Postoperative complications occurred in four patients (atelectasis, pneumothorax, pneumonia, and wound infection in one patient each). All patients had an uneventful hospital course after treatment.


CONCLUSIONS
Thoracoscopic anterior procedures can be used safely and effectively in the treatment of idiopathic scoliosis and kyphotic deformity. This minimally invasive approach might decrease procedure-related trauma, operative time, blood loss, and length of hospitalization and may also alleviate postthoracotomy pain.
Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA.
Mark J
MJ
Krasna
Xiaolong
X
Jiao
Afshin
A
Eslami
Chad M
CM
Rutter
Alan M
AM
Levine
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016025:Bone Transplantation; D002648:Child; D017586:Diskectomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology; D001261:Pulmonary Atelectasis / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013530:Surgical Wound Infection / Q000209:etiology; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome