Thoracoscopic techniques for the treatment of scoliosis

Abstract

Study design

To determine the effectiveness of an endoscopic option in an anterior approach to the thoracolumbar spine for scoliosis treatment, 50 patients with follow-ups of 24–45 months were studied retrospectively.

Objective

The objective was to develop a safe, reproducible, and effective endoscopic technique for the treatment of scoliosis that will provide equal or better outcomes compared with formal open surgical techniques.

Summary of background data

Techniques for endoscopic treatment of spinal disorders have been under development since 1993. The benefits of thoracoscopic surgery in treating spinal deformities have been documented as improved visualization of the spine, enhanced access to the extremes of the curve, decreased operative times and blood loss, shorter hospital stays and recuperative periods, and decreased overall costs. Following more than 150 endoscopic procedures for the treatment of these spinal deformities, the next progression was to develop a thoracoscopic technique of instrumentation, correction, and fusion for primary thoracic scoliosis. The goals are to gain comparable results, fusion rates, and degrees of correction that meet or exceed the current gold standards of an open procedure.

Methods

From October 1996 to October 1998, 50 patients with a diagnosis of primary thoracic scoliosis were selected to undergo a thoracoscopic technique of instrumentation, correction, and fusion. Postoperatively, patients were assessed for restoration of spinal alignment, axial derotation, pain management, and incidence of complications.

Results

Successful endoscopic instrumentation occurred in all patients. Curve correction averaged 50.2%, improving to 68.6% in the last ten cases. Patients with hypokyphosis averaged 20.7° of correction. The preoperative axial rotation, based on the scoliometer, averaged 16°, which was corrected to 5° postoperatively. Postoperative pain was less; patients were off all pain medication by 1–3 weeks compared with patients with a formal open procedure requiring pain medication for 6–12 weeks. The hospital stay averaged 2.9 days. Our initial complication rate was high, which can be attributed to the development of a new technique. The keys to successful fusions included total discectomy, complete endplate removal, and autogenous bone graft.

Conclusions

Although still in early development, the initial results of thoracoscopic techniques are promising. With experience, surgical times are decreasing and fusion and curve correction rates are improving. With further evolution, patients should realize shortened hospitalization, decreased rehabilitation times, and decreased levels of postoperative pain. This is a technically demanding procedure and requires demonstrated skills in endoscopic discectomy and fusion.