Thoracoscopic anterior instrumented fusion for adolescent idiopathic scoliosis with emphasis on the sagittal plane

Abstract

Background context: Anterior fusion through an open thoracotomy restores kyphosis more reliably than posterior techniques in patients with thoracic adolescent idiopathic scoliosis (AIS). Video-assisted thoracoscopic spinal fusion and instrumentation (VATS) minimizes the morbidity, from soft tissue and muscle dissection that accompanies traditional open thoracotomy. To our knowledge, there has not been a comprehensive analysis of VATS with respect to radiographic and clinical outcomes in the sagittal plane.

Purpose: To measure the radiographic and clinical outcomes after VATS with emphasis on the sagittal plane.

Study design/setting: A retrospective, radiographic review of 26 consecutive patients with Lenke type-I AIS who underwent VATS.

Methods: Radiographs of 26 consecutive patients with Lenke type-I AIS curves operated by a single surgeon were retrospectively reviewed after VATS. Sagittal and coronal parameters were compared with reported data for open anterior and posterior procedures.

Results: There was an increase in kyphosis from baseline to final follow-up by 6.6 degrees (25%) from T2 to T12 (p<.0001), 8.7 degrees (50%) from T5 to T12 (p<.0001), and 8 degrees (54%) in the instrumented segment (p<.0001). Junctional kyphosis did not occur. No differences were detected in sagittal measurements between the first postoperative erect and the final radiographs. Patients experienced significant improvements from baseline to 2 years in Scoliosis Research Society-22 Health-Related Quality-of-Life Outcome Questionnaire scores (p<.0001).

Conclusions: Video-assisted thoracoscopic spinal fusion and instrumentation, in agreement with results reported for open anterior instrumentation, reliably restores or increases thoracic kyphosis while preserving junctional alignment in thoracic AIS.