Thoracoscopic biopsy of a pathological vertebral body

Defining the pediatric spinal thoracoscopy learning curve: sixty-five consecutive cases

STUDY DESIGN

Consecutive case prospective chart and radiographic review.

OBJECTIVES

The purpose of this study was to define the learning curve of spinal thoracoscopy.

SUMMARY OF BACKGROUND DATA

Thoracoscopy is an alternative to open thoracotomy in the treatment of pediatric spinal deformity. The learning curve for spinal thoracoscopy has not been described.

METHODS

In this prospective study 65 consecutive cases of thoracoscopic anterior release with discectomy and fusion performed by one surgeon for the treatment of pediatric spinal deformity were reviewed. The patients were, on average, 14 +/- 3 years old and had the following diagnoses: idiopathic scoliosis (n = 13), Scheuermann's kyphosis (n = 9), neuromuscular spinal deformity (n = 35), congenital scoliosis (n = 4), and tumor/syrinx (n = 4).

RESULTS

The average operative time for the thoracoscopic procedure was 161 +/- 41 minutes (range, 50-240 minutes). There was a slight decrease in the average operative time as the series progressed. The average number of discs excised was 6.5 +/- 1.5 (range, 3-10), and the number increased as the series progressed. The average operative time per disc was 29.3 +/- 7.7 minutes in the first 30 patients compared with 22.3 +/- 4.7 minutes in the next 35 patients (P < 0.01). The average blood loss during the thoracoscopic procedure was 301 +/- 322 mL (range, 25-2000 mL) and did not decrease as the series progressed. Initial postoperative scoliosis and kyphosis corrections were 59% +/- 17% and 92% +/- 12%, respectively. Complications occurred in six patients (cases 4, 8, 17, 31, 39, and 46) and were evenly distributed throughout the series.

CONCLUSIONS

The learning curve for thoracoscopy is substantial, but not prohibitive. This technique provides a safe and effective alternative to thoracotomy in the treatment of pediatric spinal deformity.

Anterior release and fusion in pediatric spinal deformity. A comparison of early outcome and cost of thoracoscopic and open thoracotomy approaches

STUDY DESIGN

A consecutive series of patients undergoing thoracoscopic anterior spinal release and fusion for scoliosis or kyphosis was compared with a consecutive series of patients treated with an open thoracotomy approach.

OBJECTIVES

To compare the early clinical results, costs, and charges of performing an anterior thoracic spinal release and fusion with the two approaches.

SUMMARY OF BACKGROUND DATA

The thoracoscopic approach to the spine is gaining acceptance, yet there are little data comparing the technique with standard open methods for the treatment of spinal deformity.

METHODS

The first 14 thoracoscopic cases performed at the authors' hospital were compared with 18 open thoracotomy cases treated during the previous 12-month period. In each case the discs were excised and bone grafted before performing a posterior fusion. The early clinical outcomes and the hospital charges/costs were analyzed.

RESULTS

The percent curve correction was similar between the thoracoscopic and open methods: scoliosis 56% and 60%, respectively; kyphosis, 88% and 94%, respectively. The blood loss and complication rates were similar between the two groups; however, the chest tube output was greater in the thoracoscopic group. The length of hospital stay was not reduced, and the cost of the open procedure is 29% less than the thoracoscopic approach. The minimally invasive thoracoscopic approach avoids cutting the chest/shoulder musculature, greatly decreasing the morbidity of anterior spinal surgery.

CONCLUSIONS

The thoracoscopic technique is a safe and effective alternative to open thoracotomy in the approach to the anterior thoracic spine for the treatment of pediatric and adolescent spinal deformity.