Thoracoscopic Approach to Spinal Deformities

Published on 13/02/2015 by admin

Filed under Cardiothoracic Surgery

Last modified 13/02/2015

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CHAPTER 31 Thoracoscopic Approach to Spinal Deformities


The conventional approaches to the spine have been posterolateral, costotransverse, and anterior. To reach the anterior spine, anterior thoracotomy has traditionally been used. Problems associated with thoracotomy include a long incision, rib resection, significant rib spreading, tissue desiccation, alteration of pulmonary and shoulder girdle function, significant pain, associated morbidity, and poor cosmesis. The field of video-assisted thoracic surgery (VATS) presents the spinal surgeon with an endoscopic option for approaching the anterior vertebral column.

The use of video-assisted thoracoscopy can decrease the surgical morbidity associated with open procedures. The goals and objectives of this newer technique are the same as those for thoracotomy. The VATS approach to the spine has led to many exciting new techniques for treatment of the disk space. Surgical instruments, guided by an endoscope, are able to gain access to the chest through 15- to 20-mm ports rather than through the 8- to 10-inch-long incision required for thoracotomy.

In December 1993, at Children’s Hospital Medical Center in Cincinnati, we began performing VATS for the anterior release of severe spinal deformities in children and adolescents. The benefits of this procedure include minimal invasiveness, better visualization and magnification, diminished postoperative pain and ventilatory compromise, reduced blood loss, decreased hospitalization, reduced health-care costs, improved wound care, and earlier return to prehospital activities with minimal shoulder dysfunction.1

Approach to Minimally Invasive Exposure of the Thoracic Spine

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