188. THORACOSCOPIC ANTERIOR INSTRUMENTATION AND FUSION AS TREATMENT FOR ADOLESCENT IDIOPATHIC SCOLIOSIS: A SYSTEMATIC REVIEW OF THE LITERATURE

Abstract

Purpose: Traditionally, the accepted treatments for adolescent idiopathic scoliosis (AIS) have included open anterior thoracotomy with instrumentation and posterior spinal fusion and instrumentation. Thoracoscopic instrumentation is a newer technique, whose role remains controversial. This systematic review of the literature aims to better understand thoracoscopic instrumentation as a treatment for AIS and to discuss it in the context of the alternative techniques currently used.

Method: The most commonly used medical databases (PUBMED, Medline, EMBASE, Cinahl, and the Cochrane library) were searched up to April 2008 using the search terms “VATS”, “thoracoscopic scoliosis” and “thoracoscopic scoliosis instrumentation”. Two reviewers independently performed the literature evaluation. There were no language restrictions. Because the number of randomized controlled trials was anticipared to be small, we included relevant non-randomized trials, observational studies, and uncontrolled studies.

Results: Eleven studies met the strict inclusion criteria for the systematic review, of which the majority were level III and IV evidence. Four hundred and forty-five cases have been reported, 80% of them female, with the vast majority having a diagnosis of AIS. Similar surgical techniques were used and had a mean operative time of 355 minutes, mean blood loss of 444 ml, and mean hospital stay of 5.1 days. Mean pre-operative curve magnitude was 47.9o; post-operative curve magnitude was 16.3o, with a correction of 62%. Number of levels instrumented was 6.3, pulmonary function testes returned to pre-operative values by 2-years post-operative, and complication rate was 21.6%, including a pulmonary complication rate of 9.2%. SRS questionnaires revealed that patients were satisfied.

Conclusion: The major drawbacks of the thoraco-scopic approach are the operative time and incidence of early pulmonary complications. Advantages include: minimally invasive, less blood loss, short hospital stay, excellent curve correction, few levels fused, good patient satisfaction, and no long term effect on pulmonary function. With appropriate surgeon training, careful patient selection, and precise surgical technique, this technique can offer an acceptable alternative to the more traditional procedures.