Abstract
Purpose: Surgical gold standard for adolescent idiopathic scoliosis (AIS) is open posterior spinal instrumentation and fusion. This approach causes significant soft tissue disruption and paravertebral muscle detachment. This review attempts to provide an overview of the current state of knowledge of minimally invasive (MIS) surgery for AIS. Methods: The results of MIS for adult scoliosis are briefly reviewed as the rationale for its application to AIS. A review of the two currently available MIS techniques for AIS is then given, including indications, surgical technique, and results in the literature. Results: Thoracoscopic anterior spinal fusion and instrumentation (TASF) offers similar results and complication rates with decreased blood loss but is technically demanding and has limited indications. The posterior MIS technique seems to offer similar results and complication rates, decreased blood loss and shorter length of hospital stay, at the expense of a longer operative time. Conclusion: Both TASF and posterior MIS are valid alternatives to the gold standard. They have proven similar results and short-term safety to open posterior fusion, with the added theoretical advantage of a less traumatizing exposure and improved cosmesis. While TASF has fallen out of favor due to its technical challenges, specific instrumentation and limited indications, posterior MIS does not suffer from these drawbacks. The limited amount of literature on this technique warrants studies with further follow-up, demonstrating its long-term safety before recommending its routine use.
Highlights
Adolescent idiopathic scoliosis (AIS) represents the majority (51%) of the indications for scoliosis surgery at the pediatric age [1]
We describe the indications, surgical technique, and results of thoracoscopic anterior spinal fusion and instrumentation (TASF), which is currently the only minimally invasive (MIS) alternative to the posterior MIS technique for AIS, despite its fading out
Complications of Thoracoscopic anterior spinal fusion and instrumentation (TASF) are primarily due to instrumentation failure, pseudarthrosis and pulmonary issues
Summary
Adolescent idiopathic scoliosis (AIS) represents the majority (51%) of the indications for scoliosis surgery at the pediatric age [1]. Untreated, this pathology results in a normal life expectancy [2,3], in productive and high-level functioning adults, with minimal physical impairment other than decreased body satisfaction and back pain [4]. Operative treatment has drastically evolved over the last century, from posterior Harrington instrumentation and casting, which was associated with high failed fusion rates, poor deformity correction, and the need for prolonged bed rest. Anterior thoracoscopic and miniopen approaches were later developed, which resulted in significant curve correction
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