Limits...
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

Case example of 11-year-old female, Risser 0, with Cobb angle of 98° treated with an anterior thoracoscopic fusion from T5-T12 combined with a posterior spinal fusion from T2-L3 with segmental instrumentation. Ponte osteotomies were done from T6-L1. (A) Preoperative posteroanterior (PA) radiograph. (B) Preoperative lateral. (C) PA radiograph at 1 year postoperative. (D) Postoperative lateral.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4522445&req=5

Figure 3: Case example of 11-year-old female, Risser 0, with Cobb angle of 98° treated with an anterior thoracoscopic fusion from T5-T12 combined with a posterior spinal fusion from T2-L3 with segmental instrumentation. Ponte osteotomies were done from T6-L1. (A) Preoperative posteroanterior (PA) radiograph. (B) Preoperative lateral. (C) PA radiograph at 1 year postoperative. (D) Postoperative lateral.

Mentions: Severe or rigid scoliosis is the most common current reason for performing a thoracoscopic release/fusion (Fig. 3). Several authors have recommended a combined anterior release/fusion and posterior fusion/instrumentation surgery to treat severe and rigid scoliotic deformities [2223]; whereas others have recently suggested that a posterior-only procedure is sufficient [141524]. Suk et al. [14] reported the use of a posterior only approach to treat severe scoliosis of <110°. For more severe curves, an anterior approach or additional posterior techniques to supplement the posterior procedure remain an option [14].


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)

Case example of 11-year-old female, Risser 0, with Cobb angle of 98° treated with an anterior thoracoscopic fusion from T5-T12 combined with a posterior spinal fusion from T2-L3 with segmental instrumentation. Ponte osteotomies were done from T6-L1. (A) Preoperative posteroanterior (PA) radiograph. (B) Preoperative lateral. (C) PA radiograph at 1 year postoperative. (D) Postoperative lateral.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Case example of 11-year-old female, Risser 0, with Cobb angle of 98° treated with an anterior thoracoscopic fusion from T5-T12 combined with a posterior spinal fusion from T2-L3 with segmental instrumentation. Ponte osteotomies were done from T6-L1. (A) Preoperative posteroanterior (PA) radiograph. (B) Preoperative lateral. (C) PA radiograph at 1 year postoperative. (D) Postoperative lateral.
Mentions: Severe or rigid scoliosis is the most common current reason for performing a thoracoscopic release/fusion (Fig. 3). Several authors have recommended a combined anterior release/fusion and posterior fusion/instrumentation surgery to treat severe and rigid scoliotic deformities [2223]; whereas others have recently suggested that a posterior-only procedure is sufficient [141524]. Suk et al. [14] reported the use of a posterior only approach to treat severe scoliosis of <110°. For more severe curves, an anterior approach or additional posterior techniques to supplement the posterior procedure remain an option [14].

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