Results of video-assisted exposure of the anterior thoracic spine in idiopathic scoliosis

Background. The feasibility of a video-assisted anterior approach to the thoracic spine has recently been reported for a variety of spine disorders. This study compares the outcomes of the video-assisted and thoracotomy approaches. Methods. A consecutive series of 42 patients underwent video-assisted thoracic surgical anterior release and were evaluated for degree of correction reported as a change in spine curvature and pulmonary functions reported as a percent of predicted values. They were followed up for a minimum of 1 year and compared with historic controls. Results. There was no significant difference in the percentage of correction between the video-assisted and thoracotomy groups, and the angle of correction was stable over the period of follow-up. No statistically significant difference was noted for any lung volume measure except for postoperative residual volume/total lung capacity ratio (video-assisted thoracic surgery 135 +/- 16.2; thoracotomy = 147.7 +/- 17.8; p = 0.03). This marginal difference becomes more significant when severely affected patients are analyzed separately (p < 0.01). Conclusions. The video-assisted anterior spine release achieves equivalent results in idiopathic scoliosis compared with an open approach. The preservation of chest wall musculature in severely affected patients appears to play a role in limiting the deterioration in postoperative pulmonary function.