Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery

Study Design. A case series of idiopathic scoliosis patients treated with thoracoscopic anterior instrumentation was compared to a similar group of patients treated by open anterior instrumentation. Objectives. To evaluate the morbidity associated with thoracoscopic instrumentation compared to the open approach for thoracic scoliosis. Methods. A consecutive group of thoracoscopically treated patients with Lenke 1 adolescent idiopathic scoliosis was compared to similar patients gathered from the DePuy-AcroMed Harms Study Group database. Perioperative outcome measures as well as early postoperative functional outcomes (pulmonary function, shoulder strength) were compared. Results. There were 38 thoracoscopic instrumentation cases with greater than 6 months' follow-up that were compared to 68 anterior open instrumentation cases. The radiographic outcomes were similar (60% ± 11% vs. 59% ± 17% thoracic curve correction for the thoracoscopic and open groups, respectively). The reduction in forced vital capacity was significantly (P = 0.01) greater in the open group (0.6 ± 0.3 L) compared to the endoscopic group (0.4 ± 0.3 L). There was a trend towards greater return of shoulder girdle strength and range of motion 6 weeks after surgery in the thoracoscopic patients. Conclusion. The thoracoscopic approach for instrumentation of scoliosis has advantages of reduced chest wall morbidity compared with the open thoracotomy method but allows comparable curve correction.