Purpose of this study: The purpose was to evaluate short term results of thoracoscopic anterior release and fusion in adolescent scoliosis.
Material and methods: An independent observer reviewed retrospectively hospital files and X-rays of 8 consecutive patients. The average follow-up was 14 months. The mean age at the time of surgery was 12 years old, all patients were skeletally immature. The surgical technique consisted in a thoracoscopic release and fusion of the discs space followed in the same time by a posterior instrumentation and fusion. Six cases were done in the prone position, two in the lateral decubitus.
Results: The release could be done in 7 cases. In one case a severe bronchospasm prevented from doing discectomy. Four levels in average could be released and fused. The thoracoscopic time was 240 mn in average and the total surgical time 430 mn. The bleeding of the thoracoscopic procedure was minimal (less than 200 cc) in all but one case (2000 cc). The duration of the chest tube was 4.4 days. At last follow up the cosmetic advantage was obvious. The angular correction of the Cobb angle was 63 per cent (similar to our isolated posterior instrumentation). The radiologic aspect of the anterior fusion seemed to be less satisfactory than the ones of classic thoracotomies (although we did not observe any non union).
Discussion: Our experience and these results moderate the initial enthusiasm of these new techniques reported in literature. Our current indications are therefore patients at risk of crankshaft, and complementary anterior fusion of dysplasic spines. As to the major curves we still recommend the anterior release through a formal thoracotomy which allows a more complete disc excision on more levels and a more abundant graft, with a shorter surgical time, with an associated morbidity which does not seem superior.