title: The 15-Year Evolution of the Thoracoscopic Anterior Release: Does It Still Have a Role?
abstract: METHODS
  Retrospective.
  
  
  OBJECTIVE
  To determine how the indications for anterior thoracoscopic release and fusion have evolved over time.
  
  
  BACKGROUND
  Anterior release was commonly performed to correct severe spinal deformities before the advent of pedicle screw fixation. The thoracoscopic approach significantly reduced the morbidity, as compared to open thoracotomy procedures.
  
  
  METHODS
  We reviewed charts and radiographs of pediatric spinal deformity patients who underwent thoracoscopic release/fusion for their deformity from 1994 to 2008. Indications for the thoracoscopic procedure were assigned to one of the following categories: hyperkyphosis, large/stiff scoliosis, crankshaft prevention, and 'other'. We analysed indications grouped in 3-year intervals to determine how the indications for this procedure evolved over the past 15 years.
  
  
  RESULTS
  One hundred and thirty-eight patients (mean age, 15 years; range, 2-28 years) underwent the procedure, with 160 identified indications. The frequency of thoracoscopic anterior release/fusion decreased after peaking in the years 2000-2002. Initially, hyperkyphosis was the most frequent indication (15/33, 45%; 1994-1996), but declined to an intermittent indication since 2006. The use of thoracoscopy to prevent crankshaft has also declined, but remains an indication for the most immature cases (2/17, 12%; 2006-2008). Severe or rigid scoliosis is currently the most common indication for thoracoscopic release/fusion at our center (11/17, 65%; 2006-2008).
  
  
  CONCLUSIONS
  The indications for a thoracoscopic anterior release/fusion has evolved with our increased understanding of this procedure and improved posterior fixation with pedicle screw instrumentation. Thoracoscopy in select spinal deformity patients still has an important role despite its less frequent use, as compared to the past decade.
authors.affiliation: Department of Orthopedic Surgery, Thammasat University, Bangkok, Thailand.
authors.forename: Rattalerk
authors.initials: R
authors.lastname: Arunakul
authors.affiliation: Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, San Diego, CA, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Peterson
authors.affiliation: Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, San Diego, CA, USA.
authors.forename: Carrie E
authors.initials: CE
authors.lastname: Bartley
authors.affiliation: Department of Orthopedic Surgery, University of California San Diego, San Diego, CA, USA.
authors.forename: Krishna R
authors.initials: KR
authors.lastname: Cidambi
authors.affiliation: Department of Orthopedic Surgery, University of California San Diego, San Diego, CA, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Varley
authors.affiliation: Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, San Diego, CA, USA. ; Department of Orthopedic Surgery, University of California San Diego, San Diego, CA, USA.
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
keywords: Endoscopic surgical procedures; Kyphosis; Scoliosis; Spinal fusion; Video-assited thoracoscopic surgery