title: A prospective comparison of thoracoscopic vs open anterior instrumentation and spinal fusion for idiopathic thoracic scoliosis in children.
abstract: OBJECTIVE
  The management of scoliosis in children has been evolving. Anterior release, diskectomy, and anterior instrumentation and spinal fusion (AISF) may be of benefit compared with a combined anterior and posterior or a posterior-only approach. Because thoracoscopic AISF (TAISF) has the potential benefit of muscle sparing, superior cosmesis, and less pain, the authors decided to prospectively compare this newer technique with open AISF (OAISF) to evaluate whether the 2 approaches were equivalent.
  
  
  METHODS
  All children with idiopathic thoracic scoliosis undergoing AISF at a single center were prospectively examined. One hundred fifty-five children who had a minimum of 1-year follow-up were included in the study. Descriptive statistics are reported as means and SDs. Groups were compared using the independent-samples t test with Levene's test for equality of variances; a 2-tailed P value of .05 or less was considered significant.
  
  
  RESULTS
  Open AISF was performed in 114 patients and TAISF was performed in 41; there were 126 girls and 29 boys. Mean age at surgery was similar (14 +/- 3 vs 14.3 +/- 1.5 years; P = .5), as was weight (54.2 +/- 19 vs 54.6 +/- 23 kg; P = .9). There were no differences in preoperative thoracic curves (48.5 degrees +/- 14 degrees vs 49.8 degrees +/- 7 degrees; P = .6) or in the number of vertebral levels instrumented (7.7 +/- 1.3 vs 7.6 +/- 0.7; P = .7). Operative time was shorter with OAISF (383 +/- 65 vs 508 +/- 98 minutes; P < .01), and there was less estimated blood loss (924 +/- 724 vs 1218 +/- 747 mL; P = .03). The OAISF group took longer to extubate (1.4 +/- 1.2 vs 1 +/- 0.3 days; P = .03) and had slightly greater chest tube drainage (1710 +/- 730 vs 1639 +/- 515 mL; P = .5). At the 1-year follow-up, the thoracic curves were similar (17.5 degrees +/- 8 degrees vs 15.2 degrees +/- 7.5 degrees; P = .1) and percentage correction of thoracic curves was also similar (64% vs 69%).
  
  
  CONCLUSIONS
  Thoracoscopic AISF is safe and effective in correcting idiopathic childhood scoliosis. Correction of deformity with TAISF is equivalent to OAISF, although it takes longer and has more blood loss. However, it spares cutting muscle, uses smaller skin incisions, and appears to have superior cosmesis.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA. grewalh@tuhs.temple.edu
authors.forename: Harsh
authors.initials: H
authors.lastname: Grewal
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
authors.forename: Linda P
authors.initials: LP
authors.lastname: D'Andrea
authors.forename: David H
authors.initials: DH
authors.lastname: Clements
authors.forename: Scott T
authors.initials: ST
authors.lastname: Porter
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae; D013906:Thoracoscopy; D013908:Thoracotomy; D016896:Treatment Outcome