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Anterior Thoracoscopic Instrumentation in Adolescent Idiopathic Scoliosis: A Systematic Review

Study Design. A Systematic Review of published series of patients with adolescent idiopathic scoliosis treated with anterior thoracoscopic instrumentation. Objective. To conduct a systematic review of the results of thoracoscopic surgery and to compare them with those of open anterior and posterior spine instrumentation to enable surgeons judge the applicability of the method. Summary of Background Data. Instrumentation through video-assisted thoracoscopic surgery is an attractive alternative for the treatment of thoracic adolescent idiopathic scoliosis. The advantages claimed by its proponent over conventional instrumentations are better cosmesis and reduced morbidity due its minimal invasive nature. However, superiority of thoracoscopic instrumentation over conventional methods has not been proven so far. Methods. Via Medline, Pubmed, and other literature searches, 8 articles met the inclusion criteria for our systematic review. The evaluations were made according to the parameters employed for evaluating spinal deformities. Instrumentation through video-assisted thoracoscopic surgery results were compared to those of open anterior or posterior surgeries. Results. Mean number of instrumented levels was 7. The extent of disc excision was not indicated in any of the studies. The mean operative time was found to be approximately 5.2 hours. Average blood loss was 391.7 mL (100–1300 mL). The average Cobb curve correction was 64.6%. The mean preoperative kyphosis angle was 21.3°; the postoperative kyphosis angle was 25.2°. These angular corrections were found to be comparable to posterior procedures using hooks, but less than with pedicle screws. Two studies reported on patient satisfaction favoring thoracoscopic instrumentation. Instrumentation-related complications were the most predominant. Conclusion. Anterior thoracoscopic instrumentation is comparable in terms of curve correction to anterior or posterior procedures. Theoretical advantages of better cosmesis and less aggressiveness seem to be offset by the increased operative and intensive care unit time, and complication rate. More prospective studies need to be conducted to determine the benefit and general applicability of this procedure.