The gain from Video-Assisted Thoracoscopic Surgery to Spine by murplelake76

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									       The gain from Video-Assisted Thoracoscopic Surgery to Spine surgery
                           Oheneba Boachie-Adjei MD

Introduction
Video-assisted Thoracoscopic surgery (VATS) is a new technique that allows for access
to anterior spinal pathology utilizing a minimally invasive approach. Proponents of this
procedure argue that anterior thoracic spine surgery can be performed with the same
accuracy and completeness as is possible by the conventional open approach but through
much smaller skin and muscle incisions.i Advantages of VATS include decreased blood
loss, shorter hospital stay, and improved cosmesis
Indications for Thoracoscopic instrumentation for AIS include:
Progressive curves more than 50degrees, Kyphosis less than 40 degrees, No prior
thoracotomy or history of severe pulmonary disease.

In a retrospective review of patient treated with both open thoracotomy and VATS we
investigated if Video-Assisted Thoracoscopic Surgery (VATS) is equally as effective as
open thoracotomy, both combined with instrumented posterior spinal fusion, with respect
to fusion rate, percent curve correction, and functional outcome.

Methods: 22patients (ages 10 – 59) underwent VATS/instrumented posterior spinal
fusion for thoracic curvatures exceeding 50 degrees. A control cohort of patients that
were age-matched, sex-matched, and curve-magnitude-matched underwent open
thoracotomy/instrumented posterior spinal fusion. In addition to analysis of curve
correction, operative reports and medical records were analyzed for the following
outcomes: estimated operative blood loss, length of surgery, chest tube output, length of
hospitalization, and complications. Finally, functional outcome was assessed using the
Scoliosis Research Society (SRS-22) and Oswestry Disability Index (ODI) scoring
system.

Results: The VATS group (mean age 39.5) averaged 5.5 anterior levels and 11.4
posterior levels fused. The thoracotomy group (mean age 38.9) averaged 5.7 anterior
levels and 11.3 posterior levels fused. The anterior blood loss was significantly higher in
the thoracotomy group as compared with the VATS group (591cc vs. 323cc). In
addition, anterior operative time was higher in the thoracotomy group (216 minutes) than
the VATS group (172 minutes). Percent curve correction immediately post-op (45%
correction VATS; 46% correction thoracotomy) as well as at 2 year follow-up (50%
VATS; 48% thoracotomy) was nearly identical. There was no difference in post-
operative SRS scores between groups (4.18 - VATS; 4.12- thoracotomy). Neither group
had any pulmonary or neurologic complications.
Discussion:
In a recent review comparing Thoracoscopic instrumentation to posterior surgery, the
authors found no significant differences in curve correction
Complications occurred in 17.8% of VATS patients compared with 13% of posterior
procedures. An initial decreased in pulmonary function in VATS patients equalized at
follow up of 2 years
However with the newer techniques of pedicles screw fixation when VATS for AIS was
compared to Pedicles screw constructs no differences were found in coronal or sagittal
balance ATR and SRS outcomes. Fewer levels were fused in the VATS cases
VATS is equally effective as thoracotomy with respect to fusion rate, major curve
correction, and functional outcome scores. A decrease in surgical time and operative
blood loss were seen in the VATS patients.




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Open Thoracotomy for Adult scoliosis: anterior Posterior fusion




VATS procedure for Adult scoliosis: Anterior posterior fusion

								
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