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The 15-Year Evolution of the Thoracoscopic Anterior Release: Does It Still Have a Role?

Arunakul R, Peterson A, Bartley CE, Cidambi KR, Varley ES, Newton PO - Asian Spine J (2015)

Bottom Line: The thoracoscopic approach significantly reduced the morbidity, as compared to open thoracotomy procedures.Initially, hyperkyphosis was the most frequent indication (15/33, 45%; 1994-1996), but declined to an intermittent indication since 2006.The use of thoracoscopy to prevent crankshaft has also declined, but remains an indication for the most immature cases (2/17, 12%; 2006-2008).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Thammasat University, Bangkok, Thailand.

ABSTRACT

Study design: Retrospective.

Purpose: To determine how the indications for anterior thoracoscopic release and fusion have evolved over time.

Overview of literature: Anterior release was commonly performed to correct severe spinal deformities before the advent of pedicle screw fixation. The thoracoscopic approach significantly reduced the morbidity, as compared to open thoracotomy procedures.

Methods: We reviewed charts and radiographs of pediatric spinal deformity patients who underwent thoracoscopic release/fusion for their deformity from 1994 to 2008. Indications for the thoracoscopic procedure were assigned to one of the following categories: hyperkyphosis, large/stiff scoliosis, crankshaft prevention, and 'other'. We analysed indications grouped in 3-year intervals to determine how the indications for this procedure evolved over the past 15 years.

Results: One hundred and thirty-eight patients (mean age, 15 years; range, 2-28 years) underwent the procedure, with 160 identified indications. The frequency of thoracoscopic anterior release/fusion decreased after peaking in the years 2000-2002. Initially, hyperkyphosis was the most frequent indication (15/33, 45%; 1994-1996), but declined to an intermittent indication since 2006. The use of thoracoscopy to prevent crankshaft has also declined, but remains an indication for the most immature cases (2/17, 12%; 2006-2008). Severe or rigid scoliosis is currently the most common indication for thoracoscopic release/fusion at our center (11/17, 65%; 2006-2008).

Conclusions: The indications for a thoracoscopic anterior release/fusion has evolved with our increased understanding of this procedure and improved posterior fixation with pedicle screw instrumentation. Thoracoscopy in select spinal deformity patients still has an important role despite its less frequent use, as compared to the past decade.

No MeSH data available.


Related in: MedlinePlus

Frequency of diagnoses of patients. AIS, adolescent idiopathic scoliosis; JIS, juvenile idiopathic scoliosis; NM, neuromuscular; CP, cerebral palsy.
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Figure 1: Frequency of diagnoses of patients. AIS, adolescent idiopathic scoliosis; JIS, juvenile idiopathic scoliosis; NM, neuromuscular; CP, cerebral palsy.

Mentions: From the first 3 years of the study period to the final 3 years, the average Cobb angle of patients undegoing this procedure increased from 60° to 75°, while the average maximum kyphosis decreased from 77° to -19°. The distribution of diagnoses was presented in Fig. 1; idiopathic scoliosis (41%), neuromuscular scoliosis (37%), and Scheuermann kyphosis (21%) were the most common. No hyperkyphotic patients underwent anterior thoracoscopic release and fusion in the final 3 years of the study period, as compared tothe higher frequency when the technique was first introduced.


The 15-Year Evolution of the Thoracoscopic Anterior Release: Does It Still Have a Role?

Arunakul R, Peterson A, Bartley CE, Cidambi KR, Varley ES, Newton PO - Asian Spine J (2015)

Frequency of diagnoses of patients. AIS, adolescent idiopathic scoliosis; JIS, juvenile idiopathic scoliosis; NM, neuromuscular; CP, cerebral palsy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522445&req=5

Figure 1: Frequency of diagnoses of patients. AIS, adolescent idiopathic scoliosis; JIS, juvenile idiopathic scoliosis; NM, neuromuscular; CP, cerebral palsy.
Mentions: From the first 3 years of the study period to the final 3 years, the average Cobb angle of patients undegoing this procedure increased from 60° to 75°, while the average maximum kyphosis decreased from 77° to -19°. The distribution of diagnoses was presented in Fig. 1; idiopathic scoliosis (41%), neuromuscular scoliosis (37%), and Scheuermann kyphosis (21%) were the most common. No hyperkyphotic patients underwent anterior thoracoscopic release and fusion in the final 3 years of the study period, as compared tothe higher frequency when the technique was first introduced.

Bottom Line: The thoracoscopic approach significantly reduced the morbidity, as compared to open thoracotomy procedures.Initially, hyperkyphosis was the most frequent indication (15/33, 45%; 1994-1996), but declined to an intermittent indication since 2006.The use of thoracoscopy to prevent crankshaft has also declined, but remains an indication for the most immature cases (2/17, 12%; 2006-2008).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Thammasat University, Bangkok, Thailand.

ABSTRACT

Study design: Retrospective.

Purpose: To determine how the indications for anterior thoracoscopic release and fusion have evolved over time.

Overview of literature: Anterior release was commonly performed to correct severe spinal deformities before the advent of pedicle screw fixation. The thoracoscopic approach significantly reduced the morbidity, as compared to open thoracotomy procedures.

Methods: We reviewed charts and radiographs of pediatric spinal deformity patients who underwent thoracoscopic release/fusion for their deformity from 1994 to 2008. Indications for the thoracoscopic procedure were assigned to one of the following categories: hyperkyphosis, large/stiff scoliosis, crankshaft prevention, and 'other'. We analysed indications grouped in 3-year intervals to determine how the indications for this procedure evolved over the past 15 years.

Results: One hundred and thirty-eight patients (mean age, 15 years; range, 2-28 years) underwent the procedure, with 160 identified indications. The frequency of thoracoscopic anterior release/fusion decreased after peaking in the years 2000-2002. Initially, hyperkyphosis was the most frequent indication (15/33, 45%; 1994-1996), but declined to an intermittent indication since 2006. The use of thoracoscopy to prevent crankshaft has also declined, but remains an indication for the most immature cases (2/17, 12%; 2006-2008). Severe or rigid scoliosis is currently the most common indication for thoracoscopic release/fusion at our center (11/17, 65%; 2006-2008).

Conclusions: The indications for a thoracoscopic anterior release/fusion has evolved with our increased understanding of this procedure and improved posterior fixation with pedicle screw instrumentation. Thoracoscopy in select spinal deformity patients still has an important role despite its less frequent use, as compared to the past decade.

No MeSH data available.


Related in: MedlinePlus