Abstract
Introduction The use of anterior techniques to address scoliosis is well established. The method employed is dependent on the curve type, degree and the institution. There are apparent immediate perioperative advantages of an endoscopic technique over an open thoracotomy. In addition, endoscopic instrumentation and fusion has become accepted as a reliable method to address thoracic scoliosis.
Methods 101 patients have undergone anterior endoscopic instrumented correction for scoliosis at the Mater Children’s Hospital, Brisbane between 2000 and 2005. In 2002, a case series study was established to assess perioperative aspects. The majority of patients were entered into a database prospectively. A total of 83 patients were included in the study at the point of data analysis for this paper. The perioperative factors considered were: Theatre times; Blood management; Mobility; and Complications.
Results The mean age was 16 years. 75 curves were adolescent idiopathic. Eight curves were in neuromuscular patients. The majority, 59 (79%) were Lenke Type 1 curves. Operating times were divided into anaesthetic, surgical and X-ray. There was a mean reduction in anaesthetic time between the first and last 20 cases of 22 minutes (p=0.20). For X-ray this was 73 seconds (p< 0.001). The mean surgical time was 288 minutes. The mean reduction in surgical time was 76 minutes (p< 0.001). A scatter plot was also performed of surgical time versus case number. The surgical time has an apparent plateau after approximately 30 cases. This may suggest a learning curve of this number. The mean intra-operative blood loss was 380mls with no allogenic transfusions. The mean length of stay was 5.8 days. There was an overall perioperative complication rate of 12%. There were six reinsertions of ICC, one conversion to an open thoracotomy, two postoperative chest infections and one patient requiring re-intubation in intensive care due to narcosis. There were no subsequent problems for these patients with perioperative complications.
Discussion The use of endoscopic techniques to address scoliosis is employed in centres specializing in spinal deformity. The results above are comparable to those previously reported for both open and endoscopic anterior techniques. The results outlined demonstrate this to be a safe method regarding the perioperative morbidity and complications associated with the procedure.
The abstracts were prepared by Assoc Prof Bruce McPhee. Correspondence should be addressed to him at the Division of Orthopaedics, The University of Queensland, Clinical Sciences Building, Royal Brisbane Hospital, Herston, Brisbane, 4029, Australia.
