Minimally Invasive Approach
What is it?
The endoscopic system for scoliosis correction was designed to allow the surgeon to accomplish all of the goals of a traditional “open” anterior procedure, with less trauma to the muscles of the back and the rib cage. Endoscopic anterior scoliosis surgery is accomplished through the use of multiple incisions or “portals” made in the side of the chest cavity that allow the surgeon to insert instrumentation into the vertebral bodies and perform a fusion. This procedure is often referred to as being “Minimally Invasive”, because the surgeon uses several small incisions to perform the surgery compared to a single longer incision. There are several advantages of using an endoscopic system including an improved visualization of the involved anatomy inside the chest cavity and greater flexibility to place instrumentation in the anterior aspect of the spine.
Why is it done?
Endoscopic scoliosis surgery is not for everyone or every curve. There are certain forms of scoliosis that are particularly amenable to endoscopic correction, especially curves only involving the thoracic spine. Lumbar and thoracolumbar curves are better approached with a more traditional open technique. The CD HORIZON® ECLIPSE™ Spinal System was designed specifically for the endoscopic approach in the thoracic spine.
The first thing that happens after you enter the operating room is that your anesthesiologist will help you to fall asleep. Once you are completely asleep, the anesthesiologist will place a breathing tube to assist with your breathing during surgery, establish a variety of catheters in your veins, and often an arterial catheter in your wrist, all of which allow for monitoring of heart function, blood pressure, fluid status, and the depth of anesthesia during your operation. This allows the anesthesiologist to be sure that you remain completely asleep during the operation. Once this is completed, the patient is rolled onto their side, with the operative side facing up, into what is termed the “lateral decubitus position.”
A special radio lucent operating table is used that allows the surgeon to take x-rays during the procedure with a fluoroscope. This is needed to make the incisions in the proper place and at the correct level of the spine.
Endoscopic surgery requires an accomplished surgical team consisting of two operating surgeons, scrub nurses, monitoring personal, and an anesthesiologist that is skilled in single lung ventilation. All must work in concert to make the surgery safe and efficient.
Three to five incisions are made depending on the location of the scoliosis curvature, number of levels that will be operated on and the ability to visualize the spine for the safe placement of the spinal instrumentation.
The pleura is incised and retracted from the vertebral bodies. Once the surface of the spinal column is exposed, the surgeon will often remove the disc material from between the vertebra involved in the curve. This will increase the flexibility of the curve and provide a large surface area for spinal fusion. Disc removal is an important adjunct to the anterior correction of scoliosis.
Once all of the discs are removed, rib graft is harvested. There is usually an adequate amount of bone graft that can be harvested from the ribs. It is not necessary that the entire rib be removed, so a normal contour to the chest can be maintained. In certain situations where the ribs are very prominent, forming a “rib hump”, the ribs can be removed endoscopically and improve the cosmetic outcome of the procedure. This is known as a “Thoracoplasty”.
Screws are placed in the anterior vertebral body under the visual guidance of the endoscope and the fluoroscope. Once all of the screws are in place, the disc space is filled with bone graft.
A rod, cut to length, is inserted into the chest cavity and attached to the screws. Once the rod has been attached to the screws, correction is accomplished by performing a compression maneuver between the screws.
Closing the Incision
The five small incisions are closed. Once healed the scars are cosmetically small and less noticeable than a traditional scoliosis scar. Since the surgeon was in the chest cavity, a chest tube will often be used to keep the lung expanded and healthy after surgery.
It is important that you discuss the potential risks, complications, and benefits of CD HORIZON® ECLIPSE® Spinal System with your doctor prior to receiving treatment, and that you rely on your physician’s judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.