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The feasibility of anterior thoracoscopic spine surgery in children under 30 kilograms
Sean D Early1, Peter O Newton, Klane K White
1Children's Hospital, Los Angeles, California, USA.
Insights
Thoracoscopic anterior spinal surgery is safe for small pediatric patients, though increased blood loss and ICU stay occurred compared to larger patients. Outcomes were similar to open surgery, but caution is advised for very small children.
Area of Science:
- Pediatric Orthopedics
- Minimally Invasive Surgery
- Spinal Deformity Correction
Background:
- Thoracoscopic anterior spinal release and fusion are increasingly used for spinal deformities.
- The safety and efficacy in small pediatric patients (<30 kg) remain largely unestablished.
- Technical challenges and outcomes in this population require further investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of thoracoscopic anterior spinal release and fusion in pediatric patients weighing less than 30 kg.
- To compare outcomes between small thoracoscopic patients, larger thoracoscopic patients, and small patients undergoing open surgery.
Main Methods:
- Retrospective comparative study of pediatric patients undergoing thoracoscopic anterior spinal release and fusion.
- Three groups were analyzed: small thoracoscopic (<30 kg), large thoracoscopic (>30 kg), and small open (<30 kg).
- Preoperative, intraoperative, and postoperative parameters were assessed.
Main Results:
- Small thoracoscopic patients experienced significantly higher blood loss/kg and chest tube output compared to large thoracoscopic patients.
- Small thoracoscopic patients had a longer intensive care unit stay than large thoracoscopic patients.
- No significant differences in blood loss, chest tube output, or ICU stay were found between small thoracoscopic and small open surgery patients, though anesthesia preparation time was longer for the former.
Conclusions:
- Anterior thoracoscopic surgery for spinal release and fusion can be performed safely in small pediatric patients, comparable to larger patients, despite anticipated intraoperative challenges.
- Outcomes in small thoracoscopic patients were similar to those in small open surgery patients.
- Very small patients (<20 kg) may still be considered a relative contraindication, particularly for surgeons new to the technique.
Study Design:
A retrospective comparison of pediatric patients weighing less than 30 kg who underwent thoracoscopic anterior spinal release and fusion for deformity correction. This group was compared to two control groups: patients weighing over 30 kg (thoracoscopic) and patients under 30 kg (open).
Objective:
To determine the efficacy and safety of thoracoscopic anterior spinal release and fusion in small pediatric patients weighing less than 30 kg.
Summary Of Background Data:
Recently, thoracoscopic methods have been utilized to perform anterior spinal release/fusion in the treatment of pediatric and adult spinal deformity. The safety, efficacy, and technical challenges of thoracoscopic spinal surgery in small children have not been established.
Methods:
"Small thoracoscopic children," defined as those under 30 kg who had thoracoscopic spinal surgery, are the main focus of this study. They were compared to "large thoracoscopic children" (>30 kg, thoracoscopic surgery) and "small open children" (<30 kg, open surgery). Preoperative, intraoperative, and postoperative parameters were analyzed.
Results:
Small thoracoscopic children (n = 33) had greater estimated blood loss/kg body weight (13.6 mL/kg vs. 6.2 mL/kg; P= 0.003), greater chest tube output (27.5 mL/kg vs. 17.1 mL/kg; P= 0.003), and a longer intensive care unit stay (4.2 days vs. 1.5 days; P= 0.001) than did large thoracoscopic children (n = 48). Conversion to an open thoracotomy occurred in one patient from each of the thoracoscopic groups. Small thoracoscopic children required more anesthesia preparation time (79.2 minutes vs. 64.2 minutes; P= 0.002) than the small open children (n = 25). There was no significant difference in estimated blood loss, chest tube output, or intensive care unit stay between these two groups. Additionally, no significant difference was found between the three groups with regard to the number of discs excised, operative time, and total hospital stay.
Conclusion:
Despite the decreased working space within the chest and difficulties of selective intubation, anterior thoracoscopic surgery for spinal release and fusion can be performed as safely in "small" children as in "large" children; however, additional intraoperative challenges should be anticipated. Although the outcomes were similar in the small thoracoscopic children compared to the small open children, the authors believe that very small patients (under 20 kg) should remain a relative contraindication to thoracoscopic surgery, especially during a surgeon's learning curve.
