Search for
Click To Visit Sponsor
|
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.
Methods
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.
|
SpineUniverse
Editorial Board Comments:
“Dr. Picetti
has presented a comprehensive treatise on the surgical technique
for anterior thoracoscopic correction of idiopathic scoliosis.
For the consumer and patient who desire to be informed,
this is a worthwhile and valuable document to carefully
scrutinize. The reader is cautioned to not extrapolate the
information provided by Dr. Picetti to all clinical situations.
In particular, many surgeons may utilize modifications of
the strategies outlined by Dr. Picetti or may in fact use
significantly different approaches. All may be appropriate.
Dr. Picetti’s meticulous and well-prepared monograph should
be used as a guideline. It is emphasized, however, that
it is not the only way of ‘skinning the cat’.
Edward
C. Benzel, M.D. - Editorial Board, SpineUniverse.com
|
|