THORACOSCOPIC ANTERIOR SPINAL PROCEDURES IN CHILDREN

Methods: From February 1996 through July 1997, 20 patients were determ ined to be appropriate for a thoracoscopic approach for the anterior p ortion of their spinal surgery. Ages ranged from 8 to 17 years of age and weight from 20 to 70 kg. The diagnosis included severe idiopathic and neurogenic scoliosis or kyphosis (n = 20) and congenital hemiverte bra (n = 4). The procedures performed included diskectomy and anterior release from two to nine vertebral levels, hemivertebrectomy. and epi physiodesis. Four patients also had an open lumbar exposure and all ha d a posterior fusion. Results: All procedures were completed successfu lly endoscopically. Surgical times for the thoracoscopic portion of th e procedure averaged 106 minutes and total procedure times were compar able with the standard open technique. Three patients were extubated a t the end of the procedure with the majority extubated on postoperativ e day 1. Average intensive care unit stay was 1.8 days, and chest tube s were removed between postoperative day 1 and 5 (average, 2.2 days). In follow-up, surgical correction was deemed to be acceptable and equi valent to open techniques in all cases. Conclusion: This technique has proven to be safe and effective in children and appears to be associa ted with less pain and morbidity as evidenced by earlier extubation an d chest tube removal and shorter ICU stay. J Pediatr Surg 33:1168-1171 . Copyright (C) 1998 by W.B. Saunders Company.