Abstract
From February 1996 through February 2003, 77 patients were determined to be appropriate for a thoracoscopic approach for the anterior portion of their spinal surgery. Ages ranged from 8 to 17 years and weight from 20 to 75 kg. Diagnoses included severe idiopathic and neurogenic scoliosis and/or kyphosis (n = 71) and congenital hemivertebra (n = 5). The procedures performed included discectomy and anterior release from 2 to 9 vertebral levels, hemivertebrectomy, and epiphysiodesis. Six patients also had an open lumbar exposure and all had a posterior fusion. All procedures were completed successfully endoscopically. Operative times for the thoracoscopic portion of the procedure averaged 105 minutes and total procedure times were comparable to the standard open technique. Eight patients were extubated at the end of the procedure, with the majority extubated on postoperative day (POD) 1. The average ICU stay was 1.6 days and chest tubes were removed between POD 1 and 5 (mean, 2.2 days). At followup, surgical correction was deemed to be acceptable and equivalent to open techniques in all cases. This technique has proven to be safe and effective in children and appears to be associated with less pain and morbidity as evidenced by earlier extubation and chest tube removal, and shorter ICU stay.
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