The success of thoracoscopic anterior fusion in a consecutive series of 112 pediatric spinal deformity cases

Study Design. A retrospective review of a single surgeon consecutive series of video-assisted thoracoscopic anterior release and fusion. Objectives. To examine radiographic fusion rates and standard radiographic parameters of spinal deformity correction, as well as to identify possible complications of thoracoscopic anterior release and fusion in patients with a minimum of 2-year follow-up treated for spinal deformity. Summary of Background Data. Anterior release and fusion of the thoracic spine is indicated in the treatment of rigid scoliosis and kyphosis, the treatment or prevention of crankshaft growth, and in patients at increased risk for pseudarthrosis. Although early postoperative outcomes of video-assisted thoracoscopic anterior release/fusion exist in the literature, few data are available with follow-up greater than 2 years. Methods. A retrospective chart and radiograph review of 112 consecutive cases of thoracoscopic anterior release/fusion with open posterior instrumentation/fusion was performed. The diagnosis, indications, perioperative data, as well as early and delayed complications, were evaluated. Deformity correction and intervertebral fusion rates were assessed at latest follow-up (greater than or equal to2 years). Results. The diagnoses included 50 patients with neuromuscular deformity, 42 with idiopathic deformity, 10 congenital, and 10 miscellaneous etiologies. The average operative time was 160+/-41 minutes to excise and bone graft an average of 7 +/- 2 discs, with an average blood loss of 285 +/- 303 cc. The average hospital stay was 9 +/- 5 days. Fourteen percent of the patients had perioperative respiratory complications that varied from atelectasis to chylothorax. There were no long-term complications associated with the anterior surgery. Scoliosis improved from 80 +/- 12degrees to 36 +/- 17degrees, and kyphosis from 88 +/- 15degrees to 60 +/- 20degrees at latest evaluation (P less than or equal to 0.001). Evidence of a "solid" anterior arthrodesis (with >50% filling of the disc space) was present radiographically in 75% of the disc spaces with moderate interobserver reliability of the grading system (kappa = 0.49). Conclusion. Thoracoscopic anterior release and fusion of the thoracic spine is a safe and effective procedure when combined with posterior instrumentation and fusion. The primary goal of increasing the flexibility of a rigid spine and achieving a solid arthrodesis occurred in the vast majority of cases.