Prone position endoscopic transthoracic release with simultaneous posterior instrumentation for spinal deformity: a description of the technique.

Abstract

A prospective series of 15 consecutive adult patients with spinal deformity who underwent endoscopic transthoracic release with simultaneous posterior instrumentation while positioned prone. To describe the technique and clinical results of endoscopic transthoracic release performed with the patient prone (as opposed to lateral) on the concave side for scoliosis or on either side for kyphosis, with simultaneous posterior exposure, instrumentation, and correction of the deformity. Use of endoscopic surgical techniques is rapidly advancing across all subspecialties. These techniques can be used to expose and operate on the spine in a less invasive fashion, thus avoiding damage to other tissues and facilitating earlier mobilization and rehabilitation. Current endoscopic techniques with the patient in the lateral decubitus position mimic open thoracotomy. A new technique is described with the patient positioned prone, which allows simultaneous posterior exposure. Preoperative Cobb angle or thoracic kyphosis angle, maximal correction bending films, and postoperative Cobb angle or kyphosis angle were measured and compared. All perioperative morbidity, intraoperative complications, and surgical variables were prospectively documented and analyzed. There were no intraoperative technical problems with the endoscopic equipment or instruments and no immediate, 6-month, or 2-year postoperative complications related to the endoscopic component of the procedure. In the scoliosis patients, the average correction was 60%. In the kyphosis patients, the average correction was 39%. Transthoracic endoscopic techniques, compared with thoracotomy, offer a less invasive method of accessing the anterior spinal column, with the benefits of an excellent view of the area of the spine being instrumented, minimal soft tissue disruption, and an improved cosmetic result. With the simultaneous technique, staged or subsequent procedures can be eliminated, and a circumferential structural release as well as control of the mobilized spine can be achieved. This simultaneous technique can be extended for use in correction of a variety of thoracic spinal pathologies.