Skip to main content

Advertisement

SpringerLink
Log in

Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical, radiological and pulmonary function results

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Introduction

This is a prospective study of adolescent patients in whom idiopathic thoracic scoliosis was corrected by short anterior fusion through a mini-open thoracotomy approach. Clinical, radiological and pulmonary function results of minimal 2-year (2–6) follow-up are presented.

Materials and methods

Consecutive 62 patients with Lenke 1 and 2 curves, having main thoracic scoliosis of up to 75°, were prospectively included. The shoulder imbalance in Lenke 2 patients was less than 20 mm. Thoracic scoliosis was corrected by short anterior fusion. The thoracic spine was exposed by an 8-cm mini-open thoracotomy incision. The operation technique and choosing of fusion levels are thoroughly described. Complete 360° discectomies and convex side vertebral endplates osteotomies are essential for deformity corrections with short fusions. Single-rod 5.5-mm titanium implants were used. The age at the time of operation was mean 15.2 years; 56 patients had a single thoracic curve and 6 patients had a double thoracic curve. There were almost equal numbers of patients with lumbar modifier A, B or C. The average length of fusion was 5.5 (4–7) vertebrae. The average length of fusion was 3.5 (2–6) vertebrae shorter than the average curve length.

Results

The instrumented thoracic curves improved by 58.3% at 6 weeks and 56.3% at the last follow-up. Apex thoracic vertebral rotation improved by 73.78% at 6 weeks and 76.24% at the last follow-up. The non-instrumented upper thoracic curve improved by 25% in double thoracic scoliosis, where the mid-thoracic curve was selectively fused, and the non-instrumented lumbar curves improved by 33.9% at the last follow-up. The radiological changes from 6 weeks to the last follow-up were statistically not significant. The clinical rib hump improved by 54% at the last follow-up. There were no significant changes in the pulmonary function. FVC% was 81.04% preoperatively, 76.41% at 6 months and 80.38% at the 2-year follow-up. The results of SRS 24 questionnaire improved from a total of 61.40 points preoperatively to 100.50 points at 6 months and 98.62 points at the 2-year follow-up. There were no neurological or thoracotomy related complications, no pseudarthrosis, no implant pullout or breakage.

Conclusion

A good deformity correction without loss of correction or adding on, a good cosmetic result and good patient’s satisfaction were achieved through shorter than end-to-end thoracic fusions. The radiological residual deformity is acceptable. Anterior correction of thoracic scoliosis with a short spinal fusion is recommended to keep the large part of the spine mobile. A very short fusion, small thoracotomy incision, low-profile implants and complete closure of parietal pleura are keys to prevent reduction in postoperative lung function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Min K, Hahn F, Ziebarth K (2007) Short anterior correction of the thoracolumbar/lumbar curve in King 1 idiopathic scoliosis: the behaviour of the instrumented and non-instrumented curves and the trunk balance. Eur Spine J 16(1):65–72

    Article  PubMed  Google Scholar 

  2. Lowe TG, Betz R, Lenke L et al (2003) Anterior single-rod instrumentation of the thoracic and lumbar spine: saving levels. Spine 28(20):208–216

    Article  Google Scholar 

  3. Newton PO, Perry A, Bastrom MA et al (2007) Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis. Spine 32(17):1875–1882

    Article  PubMed  Google Scholar 

  4. Lonner BS, Kondrachov D, Siddiqui F et al (2006) Thoracoscopic spinal fusion compared with posterior spinal fusion for the treatment of thoracic adolescent idiopathic scoliosis. JBJS 88(A):1022–1034

    Google Scholar 

  5. Tis JE, O`Brien MF, Newton PO et al (2009) Adolescent idiopathic scoliosis treated with open instrumented anterior spinal fusion. Spine 35(1):64–70

    Article  Google Scholar 

  6. Wong HK, Hee HT, Yu Z (2004) Results of thoracoscopic instrumented fusion vs. conventional posterior instrumented fusion in adolescent idiopathic scoliosis undergoing selective thoracic fusion. Spine 29(18):2031–2038

    Article  PubMed  Google Scholar 

  7. Kishan S, Bastrom T, Betz RR (2007) Thoracoscopic scoliosis surgery affects pulmonary function less than thoracotomy at 2 years postsurgery. Spine(23):453–457

  8. Lonner BS, Auerbach JD, Estreicher MB et al (2009) Pulmonary function changes after various anterior approaches in the treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech 22(8):551–558

    Article  PubMed  Google Scholar 

  9. Kim YJ, Lenke LG, Lowe T et al (2005) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. JBJS 87(A):1534–1541

    Google Scholar 

  10. Kisan S, Bastrom T, Betz R et al (2007) Thoracoscopic scoliosis surgery affects pulmonary function less than thoracotomy at 2 years postsurgery. Spine 32(4):453–458

    Article  Google Scholar 

  11. Picetti GD, Pang D, Bueff HU (2002) Thoracoscopic techniques for the treatment of scoliosis: early results in procedure development. Neurosurgery 51:978–984

    PubMed  Google Scholar 

  12. Reddi V, Clarke DV, Arlet V (2008) Anterior thoracoscopic instrumentation in adolescent idiopathic scoliosis. A systematic review. Spine 33(18):1986–1994

    Article  PubMed  Google Scholar 

  13. Brodner W, Mun YW, Möller HB et al (2003) Short segment bone-on-bone instrumentation for single curve idiopathic scoliosis. Spine 28(20):224–233

    Article  Google Scholar 

  14. Liljenqvist UR, Bullmann V, Schulte TL et al (2006) Anterior dual rod instrumentation in idiopathic thoracic scoliosis. Eur Spine J 15:1118–1127

    Article  PubMed  Google Scholar 

  15. Brodner W, Mun Yue W, Möller HB et al (2003) Short segment bone-on-bone instrumentation for single curve idiopathic scoliosis. Spine 28(20):S224–S233

    Article  PubMed  Google Scholar 

  16. Min K, Waelchli B, Hahn F (2005) Pedicle screw instrumentation and primary thoracoplastic in thoracic idiopathic scoliosis. Eur Spine J 14(8):777–782

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Balgrist Clinic, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Kan Min, Mathias Haefeli, Daniel Mueller, Georg Klammer & Frederik Hahn

Authors
  1. Kan Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mathias Haefeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Georg Klammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frederik Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kan Min.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Min, K., Haefeli, M., Mueller, D. et al. Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical, radiological and pulmonary function results. Eur Spine J 21 (Suppl 6), 765–772 (2012). https://doi.org/10.1007/s00586-012-2156-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2156-8

Keywords

Search

Navigation