Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity

Many authors believe thoracoscopic surgery is associated with a lower level of morbidity compared to thoracotomy, for anterior release or growth arres t in spinal deformity. Others believe that anterior release achieved thorac oscopically is not as effective as that achieved with the open procedure. W e evaluated the clinical results, radiological correction and morbidity fol lowing anterior thoracoscopic surgery followed by posterior instrumentation and fusion, to see whether there is any evidence for either of these belie fs. Twenty-nine patients undergoing thoracoscopic anterior release or growt h arrest followed by posterior fusion and instrumentation were evaluated fr om a clinical and radiological viewpoint. The mean follow-up was 2 years (r ange 1-4 years). The average age was 16 years (range 5-26 years). The follo wing diagnoses were present: idiopathic scoliosis (n = 17), neuromuscular s coliosis (n = 2), congenital scoliosis (n = 1), thoracic hyperkyphosis (n = 9). All patients were satisfied with cosmesis following surgery. Twenty sc oliosis patients had a mean preoperative Cobb angle of 65.1 degrees (range 42 degrees -94 degrees) for the major curve, with an average flexibility of 34.5% (42.7 degrees). Post operative correction to 31.5 degrees (50.9%) an d 34.4 degrees (47.1%) at maximal follow-up was noted. For nine patients wi th thoracic hyperkyphosis, the Cobb angle averaged 81 degrees (range 65 deg rees -96 degrees), with hyperextension films showing an average correction to 65 degrees. Postoperative correction to an average of 58.6 degrees was m aintained at 59.5 degrees at maximal follow-up. The average number of relea sed levels was 5.1 (range 3-7) and the average duration of the thoracoscopi c procedure was 188 min (range 120-280 min). There was a decrease in this l ength of time as the series progressed. No neurologic or vascular complicat ions occurred. Postoperative complications included four recurrent pneumoth oraces, one surgical emphysema, and one respiratory infection. Thoracoscopi c anterior surgery appears a safe and effective technique for the treatment of paediatric and adolescent spinal deformity. A randomised controlled tri al, comparing open with thoracoscopic methods, is required.