Anterior surgery in the thoracic and lumbar spine: endoscopic techniques in children

Therapeutic modalities for disorders of the pediatric spine must include video-assisted thoracoscopy. The endoscopic approach to the spine has involved an evolutionary approach. What began as an isolated drainage of a vertebral abscess has continued as a method of single diskectomy, release of the anulus fibrosus with or without ligation of segmental vessels, rib resection for costoplasty, rib harvesting for intervertebral fusion and, most recently, insertion of correctional implants with or without spinal fusion. Video-assisted thoracoscopic surgery offers the potential to decrease surgical morbidity associated with traditional open procedures. The ability of video-assisted thoracoscopic surgery to achieve spinal release and the results of early outcomes and cost are comparable to those of open thoracotomy. The improvement in video technology with multichip cameras has significantly improved and enhanced the ability to identify structures in the chest through small incisions (portals). This technology allows spine surgeons to perform surgical intervention comparable to thoracotomy. Instead of using a 9- to 12-inch incision, four to five portals of approximately 2 cm are used; thus, the cosmetic efects of the scoliosis surgery are enhanced. The potential benefits of this procedure include diminished postoperative pain, decreased length of hospitalization, increased wound care, and early return to prehospital activities.