Thoracoscopic techniques for the treatment of scoliosis: early results in procedure development

The goal of this study was to determine the effectiveness of an endoscopic option for anterior approaches to the thoracolumbar spine for scoliosis treatment. Fifty patients with 24 to 45 months of follow-up data were retrospectively studied. Techniques for endoscopic treatment of spinal disorders have been under development since 1993. The benefits of thoracoscopic surgery for the treatment of spinal deformities have been documented as improved observation of the spine, enhanced access to the extremes of the curve, decreased operative times and blood losses, shorter hospital stays and recuperative periods, and decreased overall costs. After more than 150 endoscopic procedures for the treatment of these spinal deformities had been performed, the next step was to develop a thoracoscopic technique for instrumentation, correction, and fusion for the treatment of primary thoracic scoliosis. Our goal has been to develop a safe, reproducible, and effective endoscopic technique for the treatment of scoliosis that can provide equal or better outcomes, compared with formal open surgical techniques.

Between October 1996 and October 1998, 50 patients with a diagnosis of primary thoracic scoliosis were selected to undergo thoracoscopic instrumentation, correction, and fusion. Postoperatively, patients were assessed with respect to restoration of spinal alignment, axial derotation, pain management, and incidence of complications.

Endoscopic instrumentation was successfully performed for all patients. Curve correction averaged 50.2%, improving to 68.6% in the last 10 cases. Patients with hypokyphosis averaged 20.7 degrees of correction. The preoperative axial rotation (as measured with a scoliometer) averaged 16 degrees, which was corrected to 5 degrees. Postoperative pain was less, and patients could discontinue the use of all pain medications by 1 to 3 weeks, compared with patients who underwent formal open procedures, who required pain medication for 6 to 12 weeks. The hospital stays averaged 2.9 days. Our initial complication rate was high, which could be attributed to the development of a new technique. Keys to successful fusions include total discectomy, complete endplate removal, and the use of autogenous bone graft.

Although these techniques are still in early development, the initial results for our thoracoscopic techniques are promising. With experience, surgical times are decreasing and fusion and curve correction rates are improving. With further evolution, patients should realize shortened hospitalizations, decreased rehabilitation times, and decreased levels of postoperative pain. This is a technically demanding procedure that requires demonstrated skills in endoscopic discectomy and fusion.