Anterior thoracoscopic spine release in deformity surgery: a meta-analysisand review

Videoassisted thoracoscopic surgery (VATS) allows the surgeon to perform an anterior thoracoscopic spine release for spinal deformities. It is an alte rnative to open thoracotomy. Several years after its introduction the prese nt author gives an update on the indications, surgical techniques, results, and complications of this new technology. A metaanalysis of previously pub lished papers is organized in tables in an attempt to answer all the questi ons and controversies that this technique has aroused. A series of ten sele cted articles were available for review, comprising a total of 151 procedur es. No study had any long-term follow-up. Most series were pediatric and in volved a variety of etiologies (mostly neuromuscular, adolescent idiopathic scoliosis, and Scheuermann's kyphosis). The surgical technique was for mos t authors a convex side approach in the lateral decubitus through four or m ore ports in the anterior or midaxillary line. Single lung ventilation was used in most cases. Posterior surgery was carried out the same day in most cases. The total number of discs excised varied between 4 and 7, but the qu ality of disc excision was rarely reported. Most authors carried out a spin e fusion at the time of the disc release. The total VATS procedure lasted b etween 2 h 30 min and 4 h, depending on the series and the surgeon's previo us experience. In most series curves were in the range of 55 degrees-80 deg rees, with an average of 65 degrees. The percentage of Cobb angle correctio n was 55%-63% after VATS and posterior spine fusion. For kyphotic deformiti es only one series had significant numbers to allow conclusions to be drawn . The mean preoperative Cobb angle was 78 degrees and postoperatively the k yphosis was corrected to 44 degrees. Length of hospital stay was quite simi lar in most series and was around 9 days. The cost of the VATS procedure wa s studied in one series and was found to be 28% more expensive than thoraco tomy. The total complications reported were 18%; most were pulmonary compli cations with prolonged ventilatory support in patients with neuromuscular p athologies. The VATS procedure has been used with success in most series fo r pediatric curves (average Cobb angle of 65 degrees or kyphosis of 75 degr ees). No report of the surgical outcome (balance, rate of fusion, rib hump correction, cosmetic correction, pain, and patient satisfaction) was availa ble for any series. Further prospective study in eluding these parameters w ill be required to determine the real benefit of such procedures to the pat ient, bearing in mind that the correction of spinal deformities is the resu lt of the surgeon's experience, skill, and the available technology.