Mini-open anterior instrumentation with diaphragm sparing for thoracolumbar idiopathic scoliosis: its technique and clinical results |
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Authors: | Yong Qiu Feng Zhu Bin Wang Zezhang Zhu Yang Yu Xu Sun Weiwei Ma |
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Institution: | (1) The Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China |
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Abstract: | The traditional method of thoracoabdominal retroperitoneal approach requires dissection of diaphragm which bears potential
complications such as postoperatively weakened abdominal breathing and dysfunction of diaphragm. Mini-open anterior instrumentation
with diaphragm sparing is designed to minimize the damage to diaphragm and improve cosmesis. This study compared the traditional
anterior instrumentation and mini-open anterior instrumentation under the hypothesis that both results in similar surgical
outcomes in treating thoracolumbar scoliosis. In Group A, 38 patients with an average age of 16.5 years underwent mini-open
anterior instrumentation with diaphragm sparing. The average standing coronal Cobb angle was 56.4° in Group A. Thirty-eight
patients with average age of 16.7 years in Group B received traditional open approach. The preoperative average Cobb angle
was 55.8° in Group B. The average correction rate of coronal curve was 78% in group A while 75% in group B. No statistical
difference between the two groups in terms of coronal curve correction, sagittal profile restoration and estimated blood loss
was observed. The operation time was significantly higher in Group A than that in Group B. All patients in the two groups
had good healing of incisions without neurological and instrumental complications during minimal 2 year follow-up. In Groups
A and B, two patients suffered from pleural effusion, respectively. The wedging of the vertebral discs distal to the lowest
fused level occurred in three and four patients in Group A and B, respectively. One case in group B was found to be suspicious
pseudoarthrosis without loss of correction. Mini-open anterior instrumentation with diaphragm sparing could minimize the surgical
invasion as well as achieve similar clinical outcomes compared with classical anterior approach. |
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Keywords: | Minimal invasive Thoracolumbar Scoliosis Anterior instrumentation Diaphragm |
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