title: A comparative study between thoracoscopic surgery and posterior surgery using all-pedicle-screw constructs in the treatment of adolescent idiopathic scoliosis.
abstract: METHODS
  A retrospective comparative study.
  
  
  OBJECTIVE
  To present the results of thoracoscopic surgery in the treatment of adolescent idiopathic scoliosis (AIS) and to compare the results of thoracoscopic surgery with those of posterior surgery.
  
  
  BACKGROUND
  Although racoscopic scoliosis correction has attracted attention since the early 2000s, its use has declined gradually, whereas posterior surgery using pedicle screws has become popular. Few studies have compared thoracoscopic surgery with posterior pedicle screw fixation for single thoracic AIS correction.
  
  
  METHODS
  Sixty-five patients with Lenke type-1 AIS were included and followed up for a minimum of 24 months. Forty-two patients underwent thoracoscopic surgery (thoracoscopic group) and 23 patients underwent posterior surgery (posterior group). Radiographic outcomes, including the correction rate and loss of correction, perioperative morbidities, and complications, were compared.
  
  
  RESULTS
  Both groups were similar in terms of the preoperative baseline data. Although the correction rate of major thoracic curve was similar, the posterior group had a tendency to have a greater correction rate (72% vs. 66%). A loss of correction was significantly greater in the thoracoscopic group. The thoracoscopic group had a longer operation time and less intraoperative blood loss, with a lower transfusion rate than the posterior group. There was no difference at the last follow-up in terms of pain score and satisfaction. Five implant failures (12%) occurred in the thoracoscopic group and none in the posterior group. There were 3 patients with significant pulmonary complications necessitating active treatments in the thoracoscopic group.
  
  
  CONCLUSIONS
  Despite its advantages, thoracoscopic surgery is losing its place in the surgical correction of AIS because of the frequent perioperative pulmonary complications and fixation problems compared with posterior pedicle screw fixation. Nevertheless, it can be utilized in selected cases particularly in cases of patient's strong demand for minimally invasive surgery.
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Chong Suh
authors.initials: CS
authors.lastname: Lee
authors.forename: Se Jun
authors.initials: SJ
authors.lastname: Park
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Chung
authors.forename: Kyung Chung
authors.initials: KC
authors.lastname: Kang
authors.forename: Chul Hee
authors.initials: CH
authors.lastname: Jung
authors.forename: Yang Tae
authors.initials: YT
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002648:Child; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D013906:Thoracoscopy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult