Thoracoscopic scoliosis surgery affects pulmonary function less than thoracotomy at 2 years postsurgery.

Study Design. Prospective evaluation of pulmonary function before and 2 years after surgery following anterior scoliosis instrumentation. Objectives. To determine if thoracoscopic anterior scoliosis correction with instrumentation affected pulmonary function less than open thoracotomy approaches at 2 years follow-up. of Background Data. The thoracoscopic approach has been shown to have a smaller reduction in pulmonary function tests (PFTs) compared with an open thoracotomy approach following anterior thoracic instrumentation for adolescent idiopathic scoliosis in the immediate postoperative period; however, it is unclear if a difference remains 2 years following the procedure. Methods. A total of 107 patients in a multicenter adolescent idiopathic scoliosis database underwent an anterior instrumented fusion for thoracic scoliosis. PFTs assessing forced vital capacity (FVC), forced expiratory volume (FEV 1 ), and total lung capacity (TLC) were obtained prospectively before and 2 years after surgery. The patients were grouped as follows: Group I, thoracoscopic instrumented fusion (n = 36); Group II, open (thoracotomy) instrumented fusion without thoracoplasty (n = 28); and Group III, open instrumented fusion with thoracoplasty (n = 43). Results. Thoracoscopic instrumentation affected pulmonary function 2 years after surgery minimally, and on an average showed improvements in all parameters except the percent-predicted FVC, which decreased by 1% ± 11%, and percent predicted FEV, which decreased by 2% ± 9%. Improvements were noted in absolute FVC, FEV 1 , TLC, and percent-predicted TLC. This is in contrast to the patients treated with a thoracotomy, who had a greater persistent reduction in PFTs at follow-up. An added racoplasty to the thoracotomy approach, however, suited in even greater residual reduction in PFTs at follow-up, with declines in percent-predicted FVC of 15%, percent-predicted FEV 1 of 14%, and percent-predicte TLG of 8%. Conclusions. This study shows a clear advantage to the minimally invasive thoracoscopic approach with regards to pulmonary function when compared with the open thoracotomy approaches.