Video-Assisted Thoracoscopic Surgery in Scoliotic Curvatures over 70 Degrees

Scoliosis surgery in patients with large curvatures and pulmonary dysfunction is recognized to have perioperative morbidity. Video-assisted thoracoscopic surgery for anterior release and interbody fusion, followed by posterior instrumented fusion and concurrent thoracoplasty was adopted in 19 scoliosis patients with Cobb angles over 70°. Four patients were unable to receive pulmonary function testing because they were too young or mentally retarded. The remaining 15 patients were divided into 2 groups according to the preoperative percent predicted values of forced vital capacity below (Group Ⅰ, n=6) or above 50% (GroupⅡ, n=9)of normal control. The mean magnitude of the thoracic scoliotic segments in Group Ⅰ was 107°and the mean number of resected ribs for thoracoplasty was 6. The mean magnitude of the thoracic scoliotic segments in Group Ⅱ was 81.2°and the mean number of resected ribs for thoracoplasty was 4.8. Group Ⅰ had 4 major complications that were all corrected, including 1 central venous catheter-induced tension pneumothorax, 1 chylothorax, 1 deep wound infection, and 1 delayed bilateral pneumothoraces. The authors conclude that video-assisted thoracoscopic surgery and thoracoplasty are accessible for the treatment of patients with severe scoliosis and prominent rib hump deformity. One must be aware that postoperative complications are notuncommon in these patients with pulmonary compromise, and intensive lung care is mandatory.