Anterior release of scoliosis (access by thoracotomy)
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An anterior approach to the thoracic spine can be used for a number of conditions including deformity, tumour, trauma, infection, and disc pathology. In this feature the technique is used to achieve an anterior release as the first stage of treating severe adolescent idiopathic scoliosis measuring over 100 degrees. I discuss the indications and considerations around the operation and demonstrate the approach via thoracotomy.
The technique allows the discs and rib heads to be removed around the apex of the curve which increases the flexibility of the spine which can increase the curve flexibility and also increase thoracic kyphosis at the time of definitive posterior fusion. These issues are important to allow satisfactory post-operative spinal alignment in both the sagittal and coronal planes. Following this anterior release, the patient underwent a second stage posterior spinal fusion (scoliosis correction).
I consider using this technique in adolescent idiopathic scoliosis for patients with a large rigid scoliosis where the pre-operative curve Cobb angle is more than 100 degrees and does not reduce by more than 50% on a traction film. In scoliosis, the thoracic spine often develops a hypokyphosis which can worsen when coronal correction is performed; anterior release is a kyphosing operation and allows improved restoration of normal thoracic kyphosis. Since there are risks associated with this procedure, the potential benefits need to be weighed against the risks involved.
Author:Mr Stephen Morris FRCS(Tr & Orth).
Institution: The Avon Orthopaedic centre, Southmead hospital, Bristol, UK.
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Question 1 of 18
Which one of the following describes when is anterior release of scoliosis prior to posterior fusion is NOT indicated?CorrectIncorrect
Question 2 of 18
Severe scoliosis often results in which one of the followingCorrectIncorrect
Question 3 of 18
Which one of the following is a method of assessing rotational deformity associated with scoliosis?CorrectIncorrect
Question 4 of 18
Which one of the following cannot be assessed on a postero-anterior plain radiograph of the whole spine?CorrectIncorrect
Question 5 of 18
The Lenke classification of adolescent idiopathic scoliosis includes all the following except which of the following?CorrectIncorrect
Question 6 of 18
Which one of the following does NOT have any evidence for being an effective treatment alternative to anterior release of severe scoliosis?CorrectIncorrect
Question 7 of 18
For an anterior release via right thoracotomy, the patient is positioned in which one of the following positions ?CorrectIncorrect
Question 8 of 18
For a curve between T5 and T12 with the apex at T8, which one of the following is the preferred rib to be removed?CorrectIncorrect
Question 9 of 18
Which one pair of the following muscle groups are incised to approach the ribs for thoracotomy?CorrectIncorrect
Question 10 of 18
When stripping the periosteum from the rib, which one of the following structures is NOT at risk?CorrectIncorrect
Question 11 of 18
A double lumen endotracheal tube will often be required when accessing above which one of the following levels ?CorrectIncorrect
Question 12 of 18
When accessing the anterior thoracic spine via a right 6th rib thoracotomy, which one of the following groups of structures are most at risk?CorrectIncorrect
Question 13 of 18
Which one of the following describes where the segmental vessels are found?CorrectIncorrect
Question 14 of 18
During anterior release of scoliosis, which one of the following structures does NOT need to be divided?CorrectIncorrect
Question 15 of 18
Which one of the following structures does removal of the rib head allow access to?CorrectIncorrect
Question 16 of 18
Which one of the following describes where the chest tube should pass in the chest wall?CorrectIncorrect
Question 17 of 18
Post-operatively following an anterior release, which one of the following statements describes what should be seen in the chest tube drainage?CorrectIncorrect
Question 18 of 18
Which one of the following statements describes when the chest tube can be removed?CorrectIncorrect