Video-Assisted Thoracoscopy for Vertebral Body Tethering of Juvenile and Adolescent Idiopathic Scoliosis: Tips and Tricks of Surgical Multidisciplinary Management.

Sara Costanzo,Andrea Pansini,Anna Camporesi,Giulia Lanfranchi,Gloria Pelizzo,Valentina Caretti,Petar Popovic,Luca Colombo

doi:10.3390/children9010074

Sara Costanzo, Andrea Pansini + Show 6 more

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https://doi.org/10.3390/children9010074

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Abstract

VATS (video assisted thoracoscopic surgery) is routinely and successfully performed in minor and major complex thoracic procedures. This technique has been recently introduced for the treatment of severe forms of idiopathic scoliosis (IS) with the aim to repair the deformity, reduce morbidity and to prevent its progression in patients with skeletal immaturity. This study aims to present VATS in anterior vertebral body tethering (AVBT) approach to support the pediatric orthopedic surgeons during vertebral body fixation. Surgical and anesthesiologic tips and tricks are reported to assure a safe procedure. The study includes preadolescents with IS and a grade of scoliosis >40° that had a high probability of deterioration due to remaining growth (December 2018 to April 2021). Skeletal immaturity of enrolled patients was assessed by Sanders classification and Risser sign. Patients had a Risser score between 0 and 1 and a Sanders score >2 and <5. AVBT technique using VATS was performed by a senior pediatric surgeon assisting the pediatric orthopedic surgeon. Twenty-three patients have been submitted to VATS AVBT in the period of study (age range 9–14 years). The patients had a classified deformity Lenke 1A or B convex right and all types of curves were treated. In all patients, the vertebrae submitted to tethering surgery ranged from D5 to D12; mean curve correction was 43%. Three postoperative complications occurred: one late postoperative bleeding requiring a chest tube positioning on 12th postoperative day; one screw dislodged and needed to be removed; one child showed worsening of the scoliosis and needed a posterior arthrodesis. Initial results of VATS AVBT in growing patients with spinal deformities are encouraging. An appropriate selection of patients and a pediatric dedicated multidisciplinary surgical approach decrease intraoperative complications, time of operation and postoperative sequelae and guarantee an optimal outcome.

Highlights

Introduction distributed under the terms andIdiopathic scoliosis (IS) affects up to 5% of children younger than 18 years [1]
The aim of our study is to present our preliminary experience with video-assisted thoracic surgery (VATS) Anterior vertebral body tethering (AVBT), described together with surgical tips and tricks to decrease the risk of intraoperative complications, the operation time and postoperative sequelae
Good reof spinal fusionfusion are reported in termsinofterms curveofcorrection, althoughalthough the reduced sults of spinal are reported curve correction, the motility reduced of the spine leads to aleads limitation of the growth the processed segmentssegments

Summary

Introduction

Introduction distributed under the terms andIdiopathic scoliosis (IS) affects up to 5% of children younger than 18 years [1]. Anterior vertebral body tethering (AVBT) is a relatively recent technique, initially described by Crawford and Lenke [10], that allows gradual curve correction by changing the shape of the vertebra, while preserving spine mobility, with minimal associated morbidity [11,12,13]. It consists of tethering the spine using staple and screw instrumentation with a cable connecting the screws together; the cable modifies the local forces acting on the vertebrae involved and functions as an early and progressive mechanism of correction of the deformity [12]. Spinal fusion or redo tethering may be necessary in some cases [11,12]

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