The Use of Thoracoscopic Release in the Surgical Correction of Thoracic Scoliosis in Children

Abstract

IntroductionRecently, the use of thoracoscopic methods in spinal deformity surgery has increased, however, the issue of the effectiveness of combining anterior release with posterior spinal fusion compared to single-stage posterior instrumentation remains controversial, which raises the issue of the effectiveness and feasibility of their use. PurposeTo evaluate the effectiveness of endoscopic anterior release for thoracic scoliosis in children. Material and methodA retrospective analysis of the results of surgical treatment of 48 patients with idiopathic scoliosis of the thoracic spine aged 12–17 years, with a thoracic curve of more than 60°, was carried out. To determine the stability of deformity, the stability index according to A.I. Kazmin was used. (SI) defined as the ratio of the angle of deformity in the supine position to the angle of deformity in the standing position. Indications for anterior release were incomplete skeletal growth and relatively stable deformities (SI 0.75–0.85). Group 1 included 27 patients operated on in one stage without anterior release, and group 2 included 21 patients in two stages, with preliminary anterior release using video-assisted thoracoscopy. ResultsIn group 1, the average Cobb angle of deformity was 71.8° with an average stability index of 0.8. In the second group, the average cobb angle of deformity was 69.7°, the average stability index was 0.82. In group 1 after surgery, the average Cobb angle was 27.8°, with an average correction of 63.39%. In the second group, the postoperative deformity angle was 17.4°, the average correction was 76.26%. Thus, we found a statistically significant increase in postoperative correction when using a combined anterior/posterior approach (p < 0.05). ConclusionIn the study, in patients with relatively stable deformities, a statistically significant increase in the degree of postoperative correction was revealed (p < 0.05) when using a combined anterior/posterior approach. Performing an anterior thoracoscopic release for thoracic deformities can improve long-term results due to the formation of 360° spinal fusion at the apex of the deformity, as well as turning off the pathogenetic links in the progression of the deformity. Level of EvidenceIII.