Abstract
Purpose: The purpose of this study was to analyse the learning curve of video-assisted thoracoscopic surgery in a consecutive series of 70 interventions for decompression and intervertebral fusion with rib bone grafts.
Material and methods: This series was composed of 70 patients followed for at least two years. The indication of video-assisted thoracoscopic surgery was idiopathic scoliosis (n=32), neuromuscular spinal malformation (n=13), neurofibromatosis (n=1), scoliosis secondary to Marfan disease (n=1), radiation-induced scoliosis (n=1), and nonunion (n=1). The first rib was resected in three patients due to compression. Resection of an intrath-roacic neurofibroma and a benign rib tumour was performed in two patients. Anterior fusion was necessary in one patient due to fracture-displacement of the thoracic spine.
Results: Mean operative time for thoracoscopic anterior decompression with discectomy and fusion was 256 minutes (range 150–405). On the average, eight discs were removed (range 4–11). Comparison of mean operative time per disc between the first interventions (n=31) and the later interventions (n=32) did not demonstrate any significant difference. Mean blood loss during thora-coscopic anterior decompression with discectomy and fusion was 285 ml (range 50–1300).
Discussion: Definitive postoperative correction was achieved in 68% and 90% of the patients with scoliosis and kyphosis respectively. A thoracoscopy-related complication was observed in three patients. Video-assisted thoracoscopic surgery is an interesting alternative to conventional thoracotomy allowing effective safe treatment of infantile spinal malformations despite a long learning curve.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
