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Defining the pediatric spinal thoracoscopy learning curve: sixty-five consecutive cases.
P O Newton1, K G Shea, K F Granlund
1Children's Hospital San Diego, California, USA. pnewton@chsd.org
Spine
|April 18, 2000
Summary
This study defines the learning curve for spinal thoracoscopy in pediatric spinal deformity treatment. While substantial, the learning curve is not prohibitive, showing thoracoscopy is a safe alternative to open surgery.
Area of Science:
- Spine Surgery
- Pediatric Orthopedics
- Minimally Invasive Procedures
Background:
- Thoracoscopy offers an alternative to open thoracotomy for pediatric spinal deformity.
- The learning curve for spinal thoracoscopy has not been previously described.
Purpose of the Study:
- To define the learning curve associated with spinal thoracoscopy.
- To evaluate the efficacy and safety of thoracoscopic anterior release with discectomy and fusion in pediatric spinal deformity.
Main Methods:
- Prospective review of 65 consecutive cases of thoracoscopic anterior release, discectomy, and fusion.
- Patients averaged 14 years old with diagnoses including idiopathic scoliosis, Scheuermann's kyphosis, and neuromuscular spinal deformity.
- Data collected included operative time, discs excised, blood loss, and radiographic correction.
Main Results:
- Average operative time decreased significantly per disc excised as the surgeon's experience grew (29.3 min/disc vs. 22.3 min/disc, P < 0.01).
- Initial correction rates for scoliosis and kyphosis were 59% and 92%, respectively.
- Complications occurred in 6 patients and were distributed throughout the series.
Conclusions:
- The learning curve for spinal thoracoscopy is significant but manageable.
- Spinal thoracoscopy is a safe and effective alternative to thoracotomy for treating pediatric spinal deformities.