Minimally Invasive Treatment of Spinal Deformity



There has been a rapid evolution in the operative management of spinal deformity during the past century. While much has changed in the surgical theater, the goals of treatment have remained the same; to achieve balanced curve correction, obtain solid arthrodesis, prevent future deformity, improve and/or prevent back pain, and avoid cardiopulmonary compromise.1 In the first half of the 20th century, the standard of care was posterior arthrodesis followed by prolonged bed rest and casting.2 In the late 1950s, Harrington introduced instrumentation to achieve improved curve correction, lower pseudarthrosis rates, and allow early patient mobilization. Harrington utilized a nonsegmental system to distract across the concave side of a curvature and, in doing so, elongated the spine.3 The coronal plane correction achieved was desirable but the sagittal plane distraction forces resulted in a loss of lumbar lordosis and flat back syndrome in many patients.4


Pedicle Screw Curve Correction Thoracic Outlet Syndrome Open Thoracotomy Anterior Release 
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  1. 1.
    Hibbs RA, Risser JC, Ferguson AB. Scoliosis treated by the fusion operation: an end-result study of three hundred and sixty cases. J Bone Joint Surg 1931;13:91–104Google Scholar
  2. 2.
    Cobb J. Spine arthrodesis in the treatment of scoliosis. Bull Hosp Joint Dis 1958;29:187–209Google Scholar
  3. 3.
    Harrington P. Treatment of scoliosis: correction and internal fixation by spine instrumentation. J Bone Joint Surg 1962;44:591–610PubMedGoogle Scholar
  4. 4.
    Bridwell K. Spinal instrumentation in the management of adolescent scoliosis. Clin Orthop Relat Res 1997 Feb;(335): 64–72Google Scholar
  5. 5.
    Luque E. Segmental spinal instrumentation for correction of scoliosis. Clin Orthop Relat Res 1982 Mar;(163):192–198Google Scholar
  6. 6.
    Cotrel Y, Dubousset J. A new technique for segmental spinal osteosynthesis using the posterior approach. Rev Chir Orthop Reparatrice Appar Mot 1984;70(6):489–494PubMedGoogle Scholar
  7. 7.
    Suk S, Lee C, Jeong S. Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 1995; 20: 1399–1405PubMedGoogle Scholar
  8. 8.
    Hodgson A, Stock F. Anterior fusion for the treatment of tuberculosis of the spine: the operative findings and results of treatment in the first on hundred cases. J Bone Joint Surg 1960;42:295–304Google Scholar
  9. 9.
    Dwyer A, Newton N, Sherwood A. An anterior approach to scoliosis. A preliminary report. Clin Orthop Relat Res 1969 Jan-Feb;(62): 192–202Google Scholar
  10. 10.
    Lonner B. Emerging minimally invasive technologies for the mana-gement of scoliosis. Orthop Clin North Am 2007;38:431–440CrossRefPubMedGoogle Scholar
  11. 11.
    Zielke K, Pellin B. New instruments and implants for supplemen-tation of Harrington system. Z Orthop Ihre Grengeb 1976;114: 5347–5359Google Scholar
  12. 12.
    Lowe T, Peters J. Anterior spinal fusion with Zielke instrumentation for idiopathic scoliosis: a frontal and sagittal curve analysis in 36 patients. Spine 1993;18:423–426PubMedGoogle Scholar
  13. 13.
    Kaneda K, Shono Y, Satoh S, et al. New anterior instrumentation for the management of thoracolumbar and lumbar scoliosis. Application of Kaneda two rod system. Spine 1996;22:1358–1368CrossRefGoogle Scholar
  14. 14.
    Bernstein R, Hall J. Solid rod short segment anterior fusion in thoracolumbar scoliosis. J Pediatr Orthop B 1998;7:124–131PubMedGoogle Scholar
  15. 15.
    Mack M, Regan J, Bobechko W, et al. Application of thoracoscopy for diseases of the sine. Ann Thorac Surg 1993;56:736–738CrossRefPubMedGoogle Scholar
  16. 16.
    Newton P, Shea K, Granlund K. Defining the pediatric spinal thoracoscopy learning curve: sixty five consecutive cases. Spine 2000; 25:1028–1035CrossRefPubMedGoogle Scholar
  17. 17.
    Herkowitz H. Rothman-Simeone The Spine, 5th edn. Elsevier, Philadelphia, 2006Google Scholar
  18. 18.
    Vedantam R, Lenke L, Bridwell K, et al. A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis. Spine 2000;25:82–90CrossRefPubMedGoogle Scholar
  19. 19.
    Landreneau R, Hazelrigg S, Mack M. Postoperative pain related morbidity: video assisted thoracoscopy versus thoracotomy. Ann Thorac Surg 1993;56:1285–1289CrossRefPubMedGoogle Scholar
  20. 20.
    Newton P, Marks M, Faro F, et al. Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery. Spine 2003;28(20):S249–S254CrossRefPubMedGoogle Scholar
  21. 21.
    Al-Sayyad M, Crawford A, Wolf R. Early experience with video assisted thoracoscopic surgery: our first 70 cases. Spine 2004;29(17): 1945–1951CrossRefPubMedGoogle Scholar
  22. 22.
    Lenke L, Betz R, Harms J, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg 2001;83:1169–1181PubMedGoogle Scholar
  23. 23.
    Betz R, Shufflebarger H. Anterior versus posterior instrumentation for the correction of thoracic idiopathic scoliosis. Spine 2001;26: 1095–1100CrossRefPubMedGoogle Scholar
  24. 24.
    Lonner B, Kondrachor D, Siddiqi F, et al. Thoracoscopic spinal fusion compared with posterior spinal fusion for the treatment of thoracic adolescent idiopathic scoliosis. J Bone Joint Surg 2006; 88:1022–1034CrossRefPubMedGoogle Scholar
  25. 25.
    Wall E, Bylski-Austrow D, Shelton F, et al. Endoscopic discectomy increases thoracic spine flexibility as effectively as open discectomy: a mechanical study in a porcine model. Spine 1998;23:9–16CrossRefPubMedGoogle Scholar
  26. 26.
    Lonner BS, Auerbach JD, Estreicher M, et al. Video-Assisted Thoracoscopic Spinal Fusion Compared with Thoracic Pedicle Screws for Thoracic Adolescent Idiopathic Scoliosis. J Bone Joint Surg 2009;91:398–408Google Scholar
  27. 27.
    Newton P, Cardelia J, Farnsworth C, et al. A biomechanical comparison of thoracoscopic and open anterior spinal release in a goat model. Spine 1998;23(5):530–535CrossRefPubMedGoogle Scholar
  28. 28.
    Lonstein J, Carlson J. The prediction of curve progression in untreated idiopathic curve progression during growth. J Bone Joint Surg 1984;66:1061–1071PubMedGoogle Scholar
  29. 29.
    Allington N, Bowen J. Adolescent idiopathic scoliosis: treatment with the Wilmington brace: a comparison of full time and part time use. J Bone Joint Surg 1996;78A:1056–1062Google Scholar
  30. 30.
    Clayson D, Luz-Alterman S, Cataletto M, et al. Long term psychological sequelae of surgically versus nonsurgically treated scoliosis. Spine 1987;12:983–986CrossRefPubMedGoogle Scholar
  31. 31.
    Noonan K, Dolan L, Jacobson W, et al. Long term psychosocial characteristics of patients treated for idiopathic scoliosis. J Pediatr Orthop 1997;17:712–717CrossRefPubMedGoogle Scholar
  32. 32.
    Nachemson A, Peterson L. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. J Bone Joint Surg 1995;77:815–822PubMedGoogle Scholar
  33. 33.
    Braun J, Akyuz E, Udall H, et al. Three dimensional analysis of 2 fusionless scoliosis treatments: a flexible ligament tether versus a rigid shape memory alloy staple. Spine 2006;31(3):262–268CrossRefPubMedGoogle Scholar
  34. 34.
    Smith A, Von Lakum H, Wylie R. An operation for stapling vertebral bodies in congenital scoliosis. J Bone Joint Surg 1954;36A:342–348Google Scholar
  35. 35.
    Betz R, Kim J, D’Andrea, et al. An innovative technique of vertebral body stapling for the treatment of patients with adolescent idiopathic scoliosis: a feasibility, safety and utility study. Spine 2003;28(205):S255–S265CrossRefPubMedGoogle Scholar
  36. 36.
    Thompson G, Lenke L, Akbarnia B, et al. Early onset scoliosis: future directions. J Bone Joint Surg 2007;89A:163–166CrossRefGoogle Scholar
  37. 37.
    Sucato D, Girgis M. Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum and subcutaneous emphysema following intubation with a double lumen endotracheal tube for thoracoscopic anterior spinal release and fusion in a patient with idiopathic scoliosis. J Spinal Disord Tech 2002;15(2):133–138PubMedGoogle Scholar
  38. 38.
    Perez-Cruet M, Fessler R, Perin N. Review: complications of minimally invasive spinal surgery. Neurosurgery 2002;51(2): S26–S36PubMedGoogle Scholar
  39. 39.
    Dieter R, Kuzycz G. Complications and contraindications of thoracoscopy. Int Surg 1997;82:232–239PubMedGoogle Scholar
  40. 40.
    Sucato D, Elerson E. A comparison of the prone and lateral position for performing a thoracoscopic anterior release and fusion for pediatric spinal deformity. Spine 2003;28(18):2176–2180CrossRefPubMedGoogle Scholar
  41. 41.
    Hasharino A, Errico T, Lonner B, et al. Mini open thoracotomy, thoracoscopically assisted, for anterior thoracic spine release. J Bone Joint Surg Br 2002;84(Suppl III):297–298Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.NYU Hospital for Joint DiseasesNew YorkUSA

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