ABSTRACT
[Summary] Traditional anterior thoracotomy surgery for thoracic idiopathic scoliosis has amount of disadvantages such as large trauma,postoperative pain,and pulmonary function decrease.Video-assisted thoracoscopic surgery (VATS),which is considered as an effective method for the treatment of idiopathic thoracic scoliosis,can avoid those disadvantages as compared with thoracotomy surgery.Common surgical procedures include anterior spinal release with intervertebral fusion and instrumentation through video-assisted thoracoscopic surgery (IVATS).This article reviewed the history,indications,contraindications,advantages,disadvantages and outcomes of VATS in the treatment of idiopathic thoracic scoliosis.
ABSTRACT
STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to evaluate the outcomes of selective thoracic fusion with segmental pedicle screw fixation for treating thoracic idiopathic scoliosis with a minimum 5-year follow-up. SUMMARY OF THE LITERATURE REVIEW: Segmental pedicle screw fixation has been proven to achieve true segmental control and greater correction of scoliosis in both the coronal and sagittal planes. However, there is no long-term study of selective thoracic fusion with segmental pedicle screw fixation for treating thoracic idiopathic scoliosis. MATERIALS AND METHODS: We analyzed 203 thoracic idiopathic scoliosis patients (236 thoracic curves) who underwent selective thoracic fusion with segmental pedicle screw fixation. The mean patient age at the time of operation was 13.8 years (range: 8.9~18 years). RESULTS: The preoperative thoracic curve of 51+/-12 degrees was corrected to 16+/-7 degrees(69% correction with 3% loss of correction) at the most recent follow-up. The non-instrumented lumbar curve of 30+/-10 degrees was corrected to 10+/-8 degrees(66% correction with 5% loss of correction) at the most recent follow-up. The preoperative thoracic kyphosis of 18+/-11 degrees and the lumbar lordosis of 43+/-10 degrees were improved to 23+/-8 degrees and 46+/-9 degrees, respectively, at the most recent follow-up. There was no junctional kyphosis at the most recent follow-up. Coronal decompensation at the most recent follow-up occurred in 10 patients. Postoperative adding-on occurred in 17 patients who were fused two levels short of the neutral vertebra. Of the 2867 thoracic pedicle screws inserted at the thoracic level, 43 screws were found to be malpositioned (1.5%), but they did not cause neurologic complications or adversely affect the long-term results. CONCLUSIONS: Selective thoracic fusion with segmental pedicle screw fixation for treating thoracic idiopathic scoliosis had satisfactory radiographic and clinical outcomes after surgery, and the outcomes were well-maintained for a minimum of 5 years follow-up. It is a safe and effective method for preserving segments of lumbar motion as well as for the restoration and maintenance of both the coronal and sagittal alignments.
Subject(s)
Animals , Humans , Follow-Up Studies , Kyphosis , Lordosis , Retrospective Studies , Scoliosis , SpineABSTRACT
Segmentalization of spinal fixation enhances correction of the coronal plane deformity and allows preservation of normal sagittal contour offering rigid fixation. Purpose of this paper was to evaluate the efficacy and safety of segmental pedicle screw fixation in the treatment of idiopathic thoracic scoliosis. From 1987 to 1991, 78 idiopathic thoracic scoliosis patients were treated with CD instrumentation. Thirty-one were treated with hooks, 23 with pedicle screws inserted in hook pattern and 24 with segmental pedicle screws. In segmental screw group, the screws were inserted for every other on the convex side. After follow up of minimum 2 years(range:24 to 52 months), the results of coronal, sagittal and rotational correction were compared. Major curve correction was 55% with hooks, 66% with hook pattern screws and 72% with segmental screws, with loss of correction of 6%, 2% and 1% respectively. Compensatory curve correction was 57% with hooks, 67% with hook pattern screws and 70% with segmental screws. In patients with hypokyphosis, all groups showed significant improvement, with best restoration in segmental screws. Rotational correction of the apical vertebra was 19% with hooks, 26% with hook pattern screws and 59% with segmental screws. Thirteen(3%) screws were malpositioned but they did not cause neurologic impairment nor adversely affect the results of treatment. This study implies that the segmental pedicle screw fixation is safe and effective method of correcting the triplanar deformity of the thoracic idiopathic scoliolis.