The Anterior Endoscopic Approach for Correction of Spinal Anomalies

Abstract

Purpose

: Traditionally, a thoracotomy, thoracolumbar, or flank incision has been utilized for exposure to the thoracolumbar spine for anterior release, diskectomy, and fusion (RDF) for correction of significant scoliosis or kyphosis. Following the anterior procedure, posterior fusion and instrumentation have been performed through a long posterior midline incision.

Methods

: This is a retrospective study of a single institution's experience with the first 50 patients undergoing thoracoscopy and retroperitoneoscopy for correction of their spinal anomalies.

Results

: The first 50 patients underwent 51 operations between 1995 and 1999. The patients ranged in age from 2 to 21 years (mean, 14.3 years) and 32 were female. Forty-three operations involved thoracoscopic RDF and three additional operations occurred primarily in the retroperitoneum. Each of these was followed by open posterior fusion and instrumentation except in the seven young patients with congenital hemivertebrae. In five additional operations, anterior instrumentation was added to the RDF with the operation primarily in the chest in three patients and in the retroperitoneum in two patients. The minimum followup in all patients has been three years. In the RDF group alone, all but one patient have been felt to have an excellent to good correction. Of the five instrumented patients, two developed complications.

Conclusion

: Thoracoscopic and retroperitoneoscopic RDF can be performed safely and efficiently. The addition of anterior endoscopic instrumentation is a more difficult procedure and requires additional experience and training.