Learning Curve for the Thoracoscopic Correction of Spinal Deformities

Hak-Sun Kim; Hwan-Mo Lee; Sung-Hwan Moon; Kyung-Hee Kim; Jin-Oh Park; Jung-Won Ha; Dong-Eun Shin

doi:10.4184/jkss.2003.10.3.261

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Kim, Lee, Moon, Kim, Park, Ha, and Shin: Learning Curve for the Thoracoscopic Correction of Spinal Deformities

Original Article

Journal of Korean Spine Surg 2003;10(3):261-268.

Published online: 12 February 2003

DOI: https://doi.org/10.4184/jkss.2003.10.3.261

Learning Curve for the Thoracoscopic Correction of Spinal Deformities

Hak-Sun Kim, M.D., Hwan-Mo Lee, M.D., Sung-Hwan Moon, M.D., Kyung-Hee Kim, B.S., Jin-Oh Park, M.D., Jung-Won Ha, M.D.^§, Dong-Eun Shin, M.D.^§

Department of Orthopaedic Surgery, Yonsei University, Seoul, Korea

^#Department of Orthopaedic Surgery, National Health Insurance Corporation Ilsan Hospital, Korea

^§Department of Orthopaedic Surgery, Pochon CHA University, Korea

Address reprint requests to Hak-Sun Kim, M.D. Department of Orthopaedic Surgery, Youngdong Severance Hospital, Yonsei University College of Medicine #146-92 Dogok-dong, Gangnam-gu, Seoul, Korea Tel: 82-2-3497-3411, Fax: 82-2-573-5393, E-mail:haksunkim@yumc.yonsei.ac.kr

^∗ This study was supported by a grant from the Brain Korea 21 project administered by Yonsei University Medical College, Stryker Korea, Gold Medical, infra Med Korea, and DePuy Korea.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study design

Twenty- six consecutive cases were prospectively studied by chart review and radiography.

Objectives

The aim of this study was to find the learning curve of spinal thoracoscopy in spinal deformity surgery.

Summary of Literature Review

A lthough the efficacy and learning curve of thoracoscopic deformity spinal surgery are well documented in many countries, there is no report in Korea.

Methods

Twenty- six consecutive patients who were underwent VA TS were studied. Idiopathic scoliosis was diagnosed in 23 patients (King type II in 15, type III in 5, type IV in 3), neuromuscular scoliosis in 2 and kyphotic deformity in one. In 14 cases of idiopathic scoliosis VA TS for anterior release, bonegraft and instrumentation were performed. In the remaining 12 cases of anterior release, bone graft by VA TS was done without instrumentation.

Results

The average number of discs excised was 5.2± .97. The average time of surgery for the 14 cases was 7.3± 1.3 hours, which represented 1.37± .25 hours per disc. Excluding the time of instrumentation in the 26 cases, the average time for anterior release and bone grafting was 3.87± .87 hours, which represented 0.76± .18 hours per disc. The average operation time diminished as the series continued. A verage blood loss was 748.9± 254 mL, which represented 152.6± 65.6 mL per disc. The Cobb’s angle was corrected by 62% on average. Complications were found in 11 cases: screw cap breakage in 3, atelectasis in 4, and intercostal nerve injury in 4. There was no serious complication.

Conclusions

VA ST for spinal deformity is a safe and effective alternative to thoracotomy, however, the learning curve for this procedure is quite difficult.

Keywords: Scoliosis, Thoracoscopy, Learning curve

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