Thoracoscopic approach for pediatric spinal deformity

Abstract

Purpose of reviewOver the past 15 years, thoracoscopic techniques have been used for the treatment of spinal deformities in the pediatric population. Several advantages have been proposed over an open thoracotomy in the treatment of large-magnitude spinal deformities, for anterior fusion in the skeletally immature, and for instrumentation of thoracic scoliosis. Complications, mainly pulmonary, from anterior thoracic procedures have also been reported. Recently, large case series of patients treated with thoracoscopic techniques by pioneers in the field have been published. In addition, several papers outlining important basic science research have added to our understanding of thoracoscopic surgery. Recent findingsClinical and radiographic results reported in the recent literature demonstrate that thoracoscopic surgery is a safe and effective treatment for pediatric patients with spinal deformity. With thoracoscopic techniques, pulmonary function has been found to return to baseline values by 1 year postoperatively. The learning curve associated with thoracoscopy can be improved with appropriate training and complications can be minimized as the surgeon gains further experience with this technique. Summary Thoracoscopy is a demanding surgical procedure that requires specialized training, sufficient experience, and advanced anesthesia techniques to be successful. The early results of thoracoscopic surgery are encouraging, and this technique continues to evolve as further clinical and basic science studies are performed. Future studies will enhance our knowledge of thoracoscopic techniques and should continue to improve upon the current results.

Early operative morbidity in 184 cases of anterior vertebral body tethering

“…In order for stakeholders to appropriately balance their needs and concerns when opting for surgery, they must understand the costs, benefits, and risk profiles of those options. Reported benefits of anterior thoracoscopic approaches over fusion include less blood loss 17 , 18 , less muscle dissection 31 , less post-operative pain 32 , fewer levels instrumented 33 , and improved self-image and mental health SRS-22 scores compared to standard open thoracotomy approaches 34 . However, those same studies reported drawbacks including increased operative time, a steep learning curve, and increased incidence of pulmonary complications.…”