Thoracoscopic spine release before posterior instrumentation in scoliosis

Surgical repair of severe deformities of the spine requires first stage surgery to acquire flexibility between the vertebrae in the deformed area. The standard technique for anterior surgery is through a thoracotomy and excision of the discs between the vertebrae with or without bone graft. A thoracotomy has several known and common risk factors, including breathing difficulties, a painful scar, and chronic postoperative pain. The development of endoscopic methods during the past decade, including video assisted thoracoscopy, has opened new horizons and technical challenges in spinal surgery. The morbidity and mortality associated with the use of the thoracoscope are minimal in comparison with the traditional thoracotomy. Three cases are presented in which the new surgical technique was used. The intervertebral discs in the deformed area were partially excised with the aid of video assisted thoracic surgery, and because of the flexibility acquired between the vertebrae in the anterior thoracoscopic approach, the second stage operation could be performed through a posterior approach. There was 58% and 68% improvement of the idiopathic scoliotic deformity in 2 patients and almost 42% in the patient with congenital wedge vertebra. As far as is known, these are the first 3 cases reported in which thoracoscopic anterior spinal release was used in the treatment of scoliosis.