The outcomes and complications of thoracic idiopathic scoliosk via thoracoscopic instrumentation: a systematie review

Abstract

Objective To summary and evaluate the application value of thoracoscopie instrumentation on thoracic idiopathic scoliosis through literature review.Methods Publications of thoracoscopic instrumentation for thoracic idiopathic scoliosis before Jun 2011 were reviewed.Surgical outcomes,complications,pre- and post-operative pulmonary function and scoliosis research society (SRS)questionnaires were targeted for systemic review.Results Twenty-six publications correlated to our study were identified.Totally 488 patients with scoliotic (seven of them were not idiopathic scoliosis)underwent thoracoscopic instrumentation in thirteen studies.The mean operation time was 343 minutes,intra-operative blood loss was averagely 434 ml and 6.7 segment of instrumentation was done in them.The correction rate is up to 57.5％ while the thoracic kyphosis was increased from 16,4° in operation to 26.4° in post-surgery.These angular corrections were found to be comparable to conventiotnal anterior thoracotomy correction and posterior procedures using hooks,but less than those using pedicle screws.Complications were reported in125 patients (25.6％),and most of them were instrumentation-related complications.Although pulmonary function decreased significantly after operation,it would cecover to normal level after one year.SRS questionnaire showed satisfactory efficacy and cosmetics.Conclusions Thoracoscopic instrumentation is comparable in terms of curve correction with conventional anterior or posterior procedures,and also has faster pulmonary function recover,as well as the higher SRS questionnaire scores.These advantages,however,seem to be offset by the sharp learning curve,the increased operative time,and intra-operative bleeding and potential complication.Although this,the thoracoscopic instrumentation is still a good procedure for patients,especially for those who concern on the post-operative recovery and cosmetics. Key words: Sooliosis; Thoracoscopy; Postoperative complications; Quality of life; Systems analysis