Video-assisted thoracoscopic diskectomy and fusion.

Thoracoscopic diskectomy has been described in adults as an alternative to thoracotomy for access to the anterior spine for correction of scoliosis, but its use in children for correction of spinal deformities has not been reported. Eight patients have undergone video-assisted thoracoscopic diskectomy with fusion before posterior instrumentation. In five patients, the posterior fusion and instrumentation followed the thoracoscopic procedure under the same anesthesia; in three patients it was staged and performed 1 week later. The mean time required for the thoracoscopic procedure was 174 minutes. Intraoperative bleeding requiring transfusion developed in one patient. No other complications occurred. The authors conclude that the minimally invasive approach for access to the thoracic cavity for anterior diskectomy and fusion will be the preferred approach because of the potential for significant reduction in postoperative discomfort and complications such as atelectasis and pneumonia. Postoperative hospitalization may not be decreased, however, because the patient must still recover from the open posterior instrumentation and fusion operation.