Idiopathic Scoliosis: Anterior Thoracoscopic Correction
Surgical Technique for Anterior Thoracoscopic Correction of Idiopathic Scoliosis: Introduction
Advances in surgical techniques have allowed the anterior spinal column to be addressed by posterior, lateral and the anterior approach. Minimally invasive techniques have permitted access to the anterior spinal column without the potential risks of a formal thoracotomy incision.
Minimally invasive surgery has the potential to decrease the surgical morbidity of a conventional thoracotomy, with the ability to perform the same operation. The surgical approach is the only difference not the technical procedure, with all of the goals and objectives of the procedure being the same.
The thorascopic treatment of lung diseases has been performed since the early 1900’s starting with Jacobaeus’s work. The modern era of laparoscopic surgery began in the 1980’s when Semm performed the first appendectomy. Laparscopic surgery then rapidly took off after Mouret performed the first laparoscopic cholecystectomy in France. Regan began his work on the thorascopic treatment of spinal disease in the early 1990’s, presented in Dublin, Ireland. Rosenthal was the first in print with his technique of thoracic discectomy in 1994. Other papers followed with expanded indications for thorascopic surgery in deformity.
At the Kaiser Sacramento spine center we began developing techniques for the endoscopic treatment of spinal disorders in 1993. We first worked on our technique for release and fusion for kyphosis and scoliosis. Subsequently an endoscopic technique for hemiepipheodesis and hemivertebrectomy for congenital scoliosis was developed. From our previous work and that of others we found improved visualization, improved access to the extremes of the curve decreased blood loss, decreased operative time, shorter hospital stay, faster return to school and activities, and decreased over all costs. After performing over 150 endoscopic procedures for spinal deformities, the natural progression was to develop an endoscopic technique of instrumentation correction and fusion of primary thoracic scoliosis. After extensive work in the lab, in October of 1996 we performed our first scoliosis instrumentation. Our goal in developing an endoscopic technique for the treatment of scoliosis is to perform a safe, reproducible and effective procedure that is comparable or better than a formal open technique. Keeping in mind the goals of scoliosis surgery continue to be the restoration of spinal alignment and balance in all planes as well as axial derotation.
From October 1996 to April 1999 fifty patients with the diagnosis of primary thoracic scoliosis underwent endoscopic instrumentation correction and fusion by a single surgeon (GDP) Average follow - up was 19 months with a range of 6-36 months. The average age at the time of surgery was 12.7 years with a range of 9 to 40 years. There were 40 females and 10 males. The average pre-operative Cobb measurement was 58.1 degrees with a range of 44 to 98 degrees. The average coronal Cobb measurement of the compensatory curve was 39 with a range of 22 to 59.