Abstract
Introduction
Standard anterior approach to the dorsal spine using thoracotomy carries a great morbidity; video-assisted thoracic surgery (VATS) has been used as a less invasive approach for many intrathoracic disease processes; among which anterior releases in rigid dorsal scoliosis. The authors performed (VATS) in patients with Adolescent Idiopathic Scoliosis (AIS), attempting to reduce the morbidity attributable to standard open thoracotomy surgery for anterior curve release; reporting their experience with thoracoscopy as part of the treatment for adolescent idiopathic scoliosis with rigid thoracic curves.
Material and Method: A prospective randomized study of 34 cases of AIS with rigid thoracic curves underwent VATS for anterior release surgery between March 2008 and April 2013 was performed. The ages of the patients ranged from 11 to 27 years with a mean of 16.3
Results
The average follow up ranged from 22.3 to 39.2 months (mean 30.33 +/− 4.64 SD months). The mean preoperative Cobb angle was 78.4° +/− 8.87° SD on standing radiographs and 70.3° +/− 8.48° SD with the fulcrum-bending radiograph. After anterior release, the fulcrum bending radiograph showed reduction of mean Cobb angle to mean angle of 41.6° +/− 6.98°. The mean fulcrum bending flexibility index was improved from 10.41% +/− 3.97 SD (prior to VATS release) to 46.97% +/− 5.23 SD after release. VATS was successfully completed in all patients without major morbidities. The mean operative time for the anterior procedure was 123.96 minutes +/− 28.77 SD. The average number of excised discs was four.
Conclusion
Anterior spinal release using VATS may reduce postoperative morbidity and produces satisfactory degree of flexibility for rigid thoracic curves. It can be considered as a good and safe alternate to open thoracotomy for anterior release.