The use of thoracoscopy in the management of adolescent idiopathic scoliosis

Study Design. Retrospective case cohort series. Objective. To analyze the outcomes of thoracoscopy in the surgical treatment of adolescent idiopathic scoliosis. Summary of Background Data. Traditionally, progressive idiopathic scoliosis has been treated surgically with either an open posterior, anterior, or combined surgical approach. Surgical methods are being explored to minimize the extent of soft tissue disruption such as thoracoscopy followed spinal release, bone grafting, and instrumentation. Several authors have reported good results using thoracoscopy in the treatment of spinal deformity following a requisite learning curve. Methods. A consecutive case cohort series of 45 adolescent patients with idiopathic scoliosis evaluated and treated at a single institution. Patients with a progressive deformity underwent a thoracoscopically assisted curve correction, fusion, and instrumentation procedure. After surgery, patients were assessed at 1, 3, 6, and 12 months and then annually. Results. All patients underwent successful thoracoscopic instrumentation and fusion without the need for an open conversion. The average preoperative thoracolumbar Cobb measurement of the major curve was 51.6 degrees. The thoracolumbar levels instrumented anteriorly ranged from T7 to L3 and had an average postoperative Cobb angle of 6.58 degrees, with an overall improvement of 87.3%. To date, at a mean follow up of 4.6 years, all curves have maintained correction. Sagittal balance was recreated or maintained through the application of interbody femoral ring allografts. Operative times averaged 5 hours and 46 minutes, with a range of 3 hours, 48 minutes to 6 hours, 55 minutes. Hospital stays averaged 2.9 days, with a range of 2 to 7 days. All patients were completely off pain medication before their first postoperative visit at 4 weeks. Children were back to school between 2 and 4 weeks on average. There were a total of 3 complications. One patient experienced transient chest wall numbness, which resolved by 3 months. Two patients developed postoperative mucus plugging in the ventilated lung. Conclusion. Endoscopic thoracoscopic spinal deformity correction, fusion, and instrumentation is a safe and feasible method of surgical management of an adolescent patient with progressive scoliosis. The key to successful fusion is a total discectomy and complete end-plate removal. This method appears to be comparable to open procedures in terms of curve correction with significantly shorter hospitalization and rehabilitation due to less surgical discomfort. The thoracoscopic correction of adolescent scoliosis warrants continued development and evaluation as a surgical method of scoliosis correction.