Abstract
Objective: To assess if a minithoracotomy gives sufficient access to undertake satisfactory anterior release and fusion of the thoracic spine.
Design: A prospective collection of data in patients undergoing anterior spinal surgery.
Subjects and Methods: Ten patients, nine with adolescent idiopathic scoliosis (AIS) and one with congenital thoracolumbar kyphosis underwent anterior release and fusion through a minithoracotomy. A minithoracotomy being defined as a thoracotomy through an incision of ≤ 6cm. The female to male ratio was 3: 2 with an average age at the time of surgery of 13.5 years (10–15) in the scoliosis group. The patient with congenital kyphosis was operated on at 24 years of age. The mean standing pre-operative Cobb’s angle in the AIS group was 78.4° (60–110°), and this was reduced to a mean of 64° (45–85°) on bending films, with a flexibility of 18.4% (2.7–40%). The pre-operative kyphosis angle in the kyphosis patient was 60°. The thoracotomy incisions were measured with a sterile measuring tape on the completion of closure.
Results: All anterior surgery was satisfactorily achieved through a minithoracotomy with mean incision length of 6.5 cm (5.5–7). The average time taken for thoracotomy and procedure was 99 minutes (40–120) and an estimated blood loss of 116mls (50–250). Satisfactory correction was achieved in all patients with the mean improvement of the Cobb’s angle of 56% and post-operative Cobb’s angle of 34° (18–52). The post-operative kyphosis angle in the thoracolumbar kyphosis patient was 45°. The mean post-operative stay in the intensive care unit was 1.2 days (1–2); the duration of chest drain 1.5 days (1–2); blood transfusion requirement 2.9 units (1–6) and the post-operative stay on the ward 7 days (6–8). Two complications were seen comprising of minor chest infection and superficial infection of the chest drain wound requiring a course of oral antibiotics.
Conclusion: A minithoracotomy provides satisfactory access to achieve anterior release as demonstrated by satisfactory correction achieved with improved cosmesis, acceptable operation time and blood loss and with minimal complications.
Abstracts prepared by Mr. A. J. Stirling, FRCS, and Miss A. Weaver. Correspondence should be addressed to Miss A. Weaver at the Research and Teaching Centre, Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
BritSpine 2002, the second combined meeting of the British Association of Spinal Surgeons, the British Cervical Spine Society, The British Scoliosis Society and the Society for Back Pain Research, took place at the International Convention Centre in Birmingham UK between 27th February and 1st March 2002. The following presentations and posters were given and displayed.
