Abstract
PurposeStandard thoracotomy for anterior instrumentation and fusion of the thoracic spine in idiopathic scoliosis may have detrimental effects on pulmonary function. In this study we describe a less invasive anterior surgical technique and show the pre- and postoperative pulmonary function with a minimum follow-up of 2 years.MethodsTwenty patients with Lenke type 1 adolescent thoracic idiopathic scoliosis were treated with anterior spinal fusion and instrumentation. The mean preoperative Cobb angle of the thoracic curve was 53° ± 5.8. Pulmonary function tests (PFT) and radiographic evaluation was performed.ResultsThe mean postoperative correction in Cobb angle of the thoracic curve was 27° ± 8.2 (49%).The mean preoperative FEV1 was 2.81 ± 0.43 L, which increased to 3.14 ± 0.50 L at 2 years postoperatively (P = 0.000). The mean FEV1% did not change (89.60 ± 7.49% preoperatively, versus 90.53 ± 5.95% at 2 years follow-up, P = 0.467). The TLC increased from 4.62 ± 0.62 L preoperatively to 5.17 ± 0.63 L at 2 years follow-up (P = 0.000). The FEV1% at two years of follow-up improved to 104% of the FEV1% predicted value. The FEV1 improved to 97% of the FEV1 predicted value.ConclusionAnterior spinal fusion for idiopathic scoliosis by means of a minimal open thoracotomy proved to be a safe surgical technique that resulted in an improvement of pulmonary function. Our results are similar to those of thoracoscopic procedures reported in literature.
Highlights
The primary indication for spinal fusion in the treatment of thoracic scoliosis is the prevention of curve progression by stable arthrodesis
In patients with thoracic scoliosis with large curves the thoracic cage deformity has a profound effect on respiratory mechanics, which is usually that of restrictive lung disease [1]
The main advantage of an anterior approach to the thoracic spine is preservation of mobile segments through a shorter fusion: In some scoliosis’ curve patterns both proximal and distal levels can be saved, which would have been instrumented in a posterior spinal fusion [6,7,8]
Summary
The primary indication for spinal fusion in the treatment of thoracic scoliosis is the prevention of curve progression by stable arthrodesis. Besides prevention of curve progression, deterioration of pulmonary function should be avoided. The main advantage of an anterior approach to the thoracic spine is preservation of mobile segments through a shorter fusion: In some scoliosis’ curve patterns both proximal and distal levels can be saved, which would have been instrumented in a posterior spinal fusion [6,7,8]. Other advantages of an anterior approach are resection of the growth plate and thereby prevention of the crankshaft phenomenon, and correction of the curve by compression rather than distraction, which has a lower rate of neurological complications [9]
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