1 Introduction topenlarge
The aims of surgery are to:
- improve the spinal curve,
- improve the three dimensional alignment of the spine,
- prevent progression of the curve in the future
- improve cosmesis
- reduce pain
- optimize pulmonary function
- maintain neurological integrity.
This is achieved by correction of the deformity and creation of a solid arthrodesis of the deformed part of the spine.
To illustrate this procedure, we will use a right thoracic curve.
2 Approaches topenlarge
The endoscopically assisted anterior release is performed through standard portals of the anterior thoracoscopic approach .
The instrumentation is performed through a posterior approach. The lengths of the incision will depend on the levels being fused.
3 Anterior release topenlarge
The anterior release consists of a thorough discectomy and resection of annulus of the apical intervertebral discs within the proposed instrumented area of the spine.
Generally a minimum of 3-4 apical intervertebral discs are excised.
The annulus is incised from the lateral aspect of the spine with a scalpel. The disc is removed using curettes and rongeurs.
Removal of the posterior annulus is optional.
The anterior longitudinal ligament is usually not cut during this procedure and helps to protect the instruments from damaging the anterior vessels.
Removal of the posterior annulus
Due to limitation of visualization, care should be taken to excise the posterior annulus if deemed necessary. Excision of the rib head will further improve flexibility and aid in the exposure and excision of the posterior annulus.
Excision of cartilaginous end plates
The cartilaginous end plate is excised using a curette, a periosteal elevator or a chisel in order to reduce the risk of pseudoarthrosis.
4 Arthrodesis topenlarge
Morselized rib graft supplemented with bone substitutes or iliac crest bone graft is placed in the interbody spaces.