New Video Surgical Spine Procedure Means Less Risk; Much Shorter Recovery for Patients

But unlike his buddies, 16-year-old Adam struggled with a severe curvature of his spine. The scoliosis, diagnosed four years ago during a school screening, had been treated with an orthotic brace intended to stop the progression of the deformity.

But the curvature continued to worsen, at one point reaching 60 degrees, and had increasingly robbed Adam of lung capacity. Before spine surgery in January, at the Shriners Hospital in St. Louis, capacity in one of Adam's lungs had dropped to only 48 percent.

It was then that doctors in Arkansas told the family that bracing was no longer adequate treatment - surgery was a necessity.

"I had anterior spine surgery myself in 1996, and I was scared to death for Adam," recalled the boy's father, Richard Peak. "I just couldn't picture my son laid open on the operating table, with his spine exposed."

So when Lawrence Lenke, M.D., a spine surgeon at the St. Louis Shriners Hospital, suggested use of a new procedure, Richard Peak said he was immediately interested. The technique, known as video-assisted thoracoscopy, is a far less invasive method for accessing the anterior (front) spine.

Adam was the second patient to receive thoracoscopy at the St. Louis Shriners Hospital. Spine surgeons at the Philadelphia, Erie and Mexico City, Shriners Hospitals also have performed the procedure, while surgeons at the Chicago Hospital plan to do so in the near future.

During thoracoscopy, surgeons view the spine with the assistance of a video imaging scope and work with instruments inserted through four small incisions.

"We place the thoracoscope - basically a miniature camera - through one of the holes and that's what we use to see what we're doing," said David Clements, M.D., of the Philadelphia Shriners Hospital. "When the surgery is over, we cover the incisions with small Band-Aids."

Lenke agrees with his Shriners colleague that the less invasive thoracoscopic approach is an important advance in patient treatment.

"The advantage of this approach is that instead of having one large incision with a lot of muscle dissection and chest cage soreness, we do it through a series of one-inch incisions with much less morbidity to the patient's muscle tissues and respiratory function" Lenke explained.

John Lubicky, M.D., chief of staff at the Chicago Shriners Hospital, said, "The number of appropriate cases that thoracoscopy could be used for is somewhat limited, but there are cases in which it could be of help. The procedure doesn't change what is done on the inside; just the approach is different."

During Adam's thoracoscopic procedure, Lenke removed disc material from the boys spine to make it more flexible during the posterior spinal fusion that immediately followed.

Four weeks after his surgery, Adam returned to the St. Louis Hospital to meet with Lenke and spine case manager Joetta Whorton. The boy was cleared to return to school, and from all indications he is now on the road to recovery.

"I was scared, but I trusted the doctors. I knew them, knew what they were doing," Adam said. "I've been doing a lot better and I've noticed that I can breathe better."

For his part, Richard Peak commented he is grateful for Shriners Hospitals. "This surgery has been a godsend," the father related with a smile. "Before we were referred here I had no idea what the Shriners represented, but then we got here and saw all these children with such major problems. All the things that Shriners Hospitals do for families . . . . There's no way, a blue-collar family like ours could have afforded this. I just thank God for Shriners Hospitals."

Material Provided by Shriners Hospitals for Children, St. Louis
You may visit their website at www.shriners.com