http://www.ejbjs.org/cgi/content/abstract/88/5/1022
Thoracoscopic Spinal Fusion Compared with Posterior Spinal Fusion for the Treatment of Thoracic Adolescent Idiopathic Scoliosis
Baron S. Lonner, MD1, Dimitry Kondrachov, MD2, Farhan Siddiqi, MD2, Victor Hayes, MD2 and Carrie Scharf, BA1
1 212 East 69th Street, New York, NY 10021. E-mail address for B.S. Lonner: blonner@nyc.rr.com
2 Department of Orthopaedics, Long Island Jewish-North Shore University Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040
Investigation performed at Lenox Hill Hospital, New York, NY
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Background: Posterior spinal fusion with segmental instrumentation is
the gold standard for the surgical treatment of thoracic adolescent idiopathic
scoliosis. More recently, anterior surgery and video-assisted thoracoscopic
surgery with spinal instrumentation have become available. The purpose
of the present study was to compare the radiographic and clinical outcomes
as well as pulmonary function in patients managed with either anterior
thoracoscopic or posterior surgery.
Methods: Radiographic data, Scoliosis Research Society patient-based outcome
questionnaires, pulmonary function, and operative records were reviewed
for fifty-one patients undergoing surgical treatment of scoliosis. Data
were collected preoperatively, immediately postoperatively,
and at the time of the final follow-up. The radiographic parameters
that were analyzed included coronal curve correction, the most
caudad instrumented vertebra tilt angle correction, coronal
balance, and thoracic kyphosis. The operative parameters that
were evaluated included the operative time, the estimated blood
loss, the blood transfusion rate, the number of levels fused,
the type of bone graft used, and the number of intraoperative
and postoperative complications. The pulmonary function parameters
that were analyzed included vital capacity and peak flow.
Results: The thoracoscopic group included twenty-eight patients
with a mean age of 14.6 years, and the posterior fusion group
included twenty-three patients with a mean age of 14.3 years.
The percent correction was 54.5% for the thoracoscopic group
and 55.3% for the posterior group. With the numbers available,
there were no significant differences between the two groups
in terms of kyphosis (p = 0.84), coronal balance (p = 0.70),
or tilt angle (p = 0.91) at the time of the final follow-up.
The mean number of levels fused was 5.8 in the thoracoscopic
group, compared with 9.3 levels in the posterior group (p <
0.0001). The estimated blood loss in the thoracoscopic group
was significantly less than that in the posterior fusion group
(361 mL compared with 545 mL; p = 0.03), and the transfusion
rate in the thoracoscopic group was significantly lower than
that in the posterior fusion group (14% compared with 43%; p
= 0.01). Operative time in the thoracoscopic group was significantly
greater than that in the posterior group (6.0 compared with
3.3 hours, p < 0.0001). There were no intraoperative complications
in either group. Vital capacity and peak flow had returned to
baseline levels in both groups at the time of the final follow-up.
Patients in the thoracoscopic group scored higher than those
in the posterior group in terms of the total score (p < 0.0001)
and all of the domains (p < 0.01) of the Scoliosis Research Society
questionnaire at the time of the final follow-up.
Conclusions: Thoracoscopic spinal instrumentation compares favorably with
posterior fusion in terms of coronal plane curve correction
and balance, sagittal contour, the rate of complications, pulmonary
function, and patient-based outcomes. The advantages of the
procedure include the need for fewer levels of spinal fusion,
less operative blood loss, lower transfusion requirements, and
improved cosmesis as a result of small, well-hidden incisions.
However, the operative time for the thoracoscopic procedure
was nearly twice that for the posterior approach. Additional
study is needed to determine the precise role of thoracoscopic
spinal instrumentation in the treatment of thoracic adolescent
idiopathic scoliosis.
Level of Evidence: Therapeutic
Level III. See Instructions to
Authors for a complete description of levels of evidence.
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