Minimally Invasive Thoracoscopic Surgery for Scoliosis
Baron S. Lonner, M.D.Orthopaedic Surgeon
As one of only a handful of surgeons in the country who performs this surgery, I am pleased to provide you with some important information about this latest surgical technique.
For patients with severe thoracic scoliosis, surgery to correct their deformity is sometimes necessary. Traditional spinal surgery usually involves making a large incision up and down the middle of the back, and spreading apart (or retracting) the back muscles to access the spine. This is commonly referred to as an "open" technique. This type of surgical procedure often requires a long hospital stay, a long and sometimes painful recovery period and leaves patients with a large scar.
Today, thanks to scientific and technological advancements, a minimally invasive technique called Video-Assisted Thoracoscopic Surgery (VATS) is now available to many patients with this type of scoliosis.
The procedure
VATS is a minimally invasive surgical procedure. As the name suggests, minimally invasive spine surgery allows the surgeon to make smaller incisions in the skin and avoid large muscle retraction.
In the VATS procedure, the patient is placed on his or her side. Several small incisions, termed portals, are made on the side of the chest wall and one lung is deflated (this is called single lung ventilation) to increase access to the thoracic spine. A thin telescope-like instrument with a tiny video camera and light at its tip (called an endoscope), is inserted through one of the incisions. This allows me to see video images of the spine "inside" the body on a computer monitor in the operating room. Small hollow tubes are then inserted through the other incisions. Using the video monitor as a guide, I then insert specialized surgical instruments through the portals to perform the fusion surgery necessary to correct the scoliosis.
Fusion to correct scoliosis
Spinal fusion surgery is performed to straighten and stabilize the spine in patients with scoliosis. The VATS procedure allows me to use the endoscope and video monitor to remove the intervertebral discs and adjoining endplates of the vertebrae in the area of the curvature. Bone graft, taken from the patient’s ribs, is then packed between the vertebrae in order to "fuse" them together. A surgical implant consisting of screws and a rod is placed to ensure correction of the curvature and to help successful fusion to take place. In adolescents and young adults with certain thoracic curve types, the procedure can be done from this approach alone. In adults with severe, rigid curvature, a combined approach with VATS and more traditional techniques may be required.
Recovery
Correction of thoracic scoliosis using the VATS procedure demonstrates a remarkable advancement in corrective spinal surgery. Patient recovery is enhanced by the procedure. Most of my patients who undergo endoscopic instrumentation are out of bed walking the day after surgery and are released from the hospital within a few days! Spinal bracing for three months is necessary following the surgery.
Case Example
This adolescent girl had a 50° curvature treated by thoracoscopic technique resulting in excellent correction. Note the spontaneous correction of the un-operated lumbar curvature. Also note the small, well-hidden incisions associated with the procedure.
Is it for everyone?
Minimally invasive thorocoscopic techniques such as VATS are not appropriate for everyone with thoracic scoliosis, especially patients:
* who cannot tolerate single lung ventilation
* with severe pulmonary (lung) disease or infection
* who have had previous anterior surgery
* with double thoracic curves
However, it has always been my top priority to provide the best care for my patients, not simply to use the latest technology. Even the "traditional" procedures have evolved over the last several years allowing us to achieve more correction of curvature and quicker return to full activites (often by 3-4 months). For this reason, I continue to perform more traditional surgical procedures because often they are the best option for successful treatment. If you or your child have thoracic scoliosis, we can discuss your specific case and find a treatment plan that is best for you.
More Spinal Information
Adult Scoliosis Treatment OverviewAdult Degenerative Scoliosis
Preparation and Home Care Instructions for Scoliosis Surgery
Minimally Invasive Spine Surgery
Congenital Scoliosis