A comparison between the prone and lateral position for performing a thoracoscopic anterior release and fusion for pediatric spinal deformity

Daniel J. Sucato, Emily Elerson

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Study Design. Retrospective review of all patients who had a single stage thoracoscopic anterior release and spine fusion followed by a posterior spinal fusion with posterior instrumentation. Objective. To analyze the results and complications of patients undergoing a thoracoscopic anterior release and fusion comparing those performed prone with those in the lateral position. Summary of Background Data. The lateral position has traditionally been used when performing a thoracoscopic anterior spinal release and fusion during a single-stage anterior spinal release and fusion/posterior spinal fusion with instrumentation. Although some have reported the thoracoscopic technique in the prone position, there are no direct comparison studies between the prone and lateral position. Methods. A retrospective review was performed of all patients who had a single stage thoracoscopic anterior spinal release and fusion and posterior spinal fusion with instrumentation from a single institution. The medical record was reviewed to determine demographic data, positioning of the patient, levels fused, anesthesia time, operative time, chest tube drainage, and complications. Radiographs were reviewed to determine preoperative curve magnitude and postoperative curve correction. The Student t test was used to compare groups and statistical significance was defined as P < 0.05. Results. There were 16 patients in the prone group and 27 in the lateral group. Adolescent idiopathic scoliosis was the most common diagnosis in both groups. All patients had a single-stage thoracoscopic anterior spinal release and fusion/posterior spinal fusion with instrumentation. In the prone group, the patient was positioned prone on a Hall-Relton frame of roll (small patients) for both the anterior spinal release and fusion and posterior spinal fusion with instrumentation. There were no significant differences between the prone and lateral groups with respect to age, gender, height, weight, and curve magnitude (73.8° vs. 71.5°). There were fewer fused anterior levels in the prone group (5.3 vs. 6.2) (P = 0.05). When analyzing parameters that reflect potential difficulties imposed by the prone position, there were no statistically significant differences noted between groups, although there was a trend toward less anterior operative time per disc (24.3 vs. 25.9 minutes/disc), greater blood loss/anterior disc level (33.5 vs. 26.8 cc/disc), greater total chest tube drainage (445 vs. 419 cc), and less days with the chest tube in place (2.2 vs. 2.3 days) for the prone group when compared to the lateral group. There were statistically significant differences between the prone and lateral groups with respect to anesthesia preparation time (42.8 vs. 64.8 minutes), delay between the completion of the anterior procedure and the start of the posterior procedure (11.8 vs. 69.5 minutes), and the incidence of complications related to the use of single-lung ventilation (0 vs. 14.8%)(P < 0.05). Patients in the prone group required less time on oxygen after surgery (34.8 vs. 51.6 hours) and were discharged home earlier (4.6 vs. 5.5 days) (P < 0.05). Conclusions. A thoracoscopic anterior spinal release and fusion in the prone position appears to achieve the same results as when performed in the lateral position for pediatric spinal deformity. The prone position saves time in the operating room due to decreasing the time needed by the anesthesiologists and the transition time between the anterior and posterior procedures. Potentially serious complications related to single-lung ventilation are avoided with bilateral-lung ventilation in the prone position.

Original languageEnglish (US)
Pages (from-to)2176-2180
Number of pages5
JournalSpine
Volume28
Issue number18
DOIs
StatePublished - Sep 15 2003

Fingerprint

Prone Position
Spinal Fusion
Pediatrics
Chest Tubes
One-Lung Ventilation
Operative Time
Drainage
Anesthesia
Patient Positioning
Scoliosis
Operating Rooms
Medical Records
Ventilation
Spine
Demography

Keywords

  • Pediatric spinal deformity
  • Prone
  • Respiratory complications
  • Thoracoscopy

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

A comparison between the prone and lateral position for performing a thoracoscopic anterior release and fusion for pediatric spinal deformity. / Sucato, Daniel J.; Elerson, Emily.

In: Spine, Vol. 28, No. 18, 15.09.2003, p. 2176-2180.

Research output: Contribution to journalArticle

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N2 - Study Design. Retrospective review of all patients who had a single stage thoracoscopic anterior release and spine fusion followed by a posterior spinal fusion with posterior instrumentation. Objective. To analyze the results and complications of patients undergoing a thoracoscopic anterior release and fusion comparing those performed prone with those in the lateral position. Summary of Background Data. The lateral position has traditionally been used when performing a thoracoscopic anterior spinal release and fusion during a single-stage anterior spinal release and fusion/posterior spinal fusion with instrumentation. Although some have reported the thoracoscopic technique in the prone position, there are no direct comparison studies between the prone and lateral position. Methods. A retrospective review was performed of all patients who had a single stage thoracoscopic anterior spinal release and fusion and posterior spinal fusion with instrumentation from a single institution. The medical record was reviewed to determine demographic data, positioning of the patient, levels fused, anesthesia time, operative time, chest tube drainage, and complications. Radiographs were reviewed to determine preoperative curve magnitude and postoperative curve correction. The Student t test was used to compare groups and statistical significance was defined as P < 0.05. Results. There were 16 patients in the prone group and 27 in the lateral group. Adolescent idiopathic scoliosis was the most common diagnosis in both groups. All patients had a single-stage thoracoscopic anterior spinal release and fusion/posterior spinal fusion with instrumentation. In the prone group, the patient was positioned prone on a Hall-Relton frame of roll (small patients) for both the anterior spinal release and fusion and posterior spinal fusion with instrumentation. There were no significant differences between the prone and lateral groups with respect to age, gender, height, weight, and curve magnitude (73.8° vs. 71.5°). There were fewer fused anterior levels in the prone group (5.3 vs. 6.2) (P = 0.05). When analyzing parameters that reflect potential difficulties imposed by the prone position, there were no statistically significant differences noted between groups, although there was a trend toward less anterior operative time per disc (24.3 vs. 25.9 minutes/disc), greater blood loss/anterior disc level (33.5 vs. 26.8 cc/disc), greater total chest tube drainage (445 vs. 419 cc), and less days with the chest tube in place (2.2 vs. 2.3 days) for the prone group when compared to the lateral group. There were statistically significant differences between the prone and lateral groups with respect to anesthesia preparation time (42.8 vs. 64.8 minutes), delay between the completion of the anterior procedure and the start of the posterior procedure (11.8 vs. 69.5 minutes), and the incidence of complications related to the use of single-lung ventilation (0 vs. 14.8%)(P < 0.05). Patients in the prone group required less time on oxygen after surgery (34.8 vs. 51.6 hours) and were discharged home earlier (4.6 vs. 5.5 days) (P < 0.05). Conclusions. A thoracoscopic anterior spinal release and fusion in the prone position appears to achieve the same results as when performed in the lateral position for pediatric spinal deformity. The prone position saves time in the operating room due to decreasing the time needed by the anesthesiologists and the transition time between the anterior and posterior procedures. Potentially serious complications related to single-lung ventilation are avoided with bilateral-lung ventilation in the prone position.

AB - Study Design. Retrospective review of all patients who had a single stage thoracoscopic anterior release and spine fusion followed by a posterior spinal fusion with posterior instrumentation. Objective. To analyze the results and complications of patients undergoing a thoracoscopic anterior release and fusion comparing those performed prone with those in the lateral position. Summary of Background Data. The lateral position has traditionally been used when performing a thoracoscopic anterior spinal release and fusion during a single-stage anterior spinal release and fusion/posterior spinal fusion with instrumentation. Although some have reported the thoracoscopic technique in the prone position, there are no direct comparison studies between the prone and lateral position. Methods. A retrospective review was performed of all patients who had a single stage thoracoscopic anterior spinal release and fusion and posterior spinal fusion with instrumentation from a single institution. The medical record was reviewed to determine demographic data, positioning of the patient, levels fused, anesthesia time, operative time, chest tube drainage, and complications. Radiographs were reviewed to determine preoperative curve magnitude and postoperative curve correction. The Student t test was used to compare groups and statistical significance was defined as P < 0.05. Results. There were 16 patients in the prone group and 27 in the lateral group. Adolescent idiopathic scoliosis was the most common diagnosis in both groups. All patients had a single-stage thoracoscopic anterior spinal release and fusion/posterior spinal fusion with instrumentation. In the prone group, the patient was positioned prone on a Hall-Relton frame of roll (small patients) for both the anterior spinal release and fusion and posterior spinal fusion with instrumentation. There were no significant differences between the prone and lateral groups with respect to age, gender, height, weight, and curve magnitude (73.8° vs. 71.5°). There were fewer fused anterior levels in the prone group (5.3 vs. 6.2) (P = 0.05). When analyzing parameters that reflect potential difficulties imposed by the prone position, there were no statistically significant differences noted between groups, although there was a trend toward less anterior operative time per disc (24.3 vs. 25.9 minutes/disc), greater blood loss/anterior disc level (33.5 vs. 26.8 cc/disc), greater total chest tube drainage (445 vs. 419 cc), and less days with the chest tube in place (2.2 vs. 2.3 days) for the prone group when compared to the lateral group. There were statistically significant differences between the prone and lateral groups with respect to anesthesia preparation time (42.8 vs. 64.8 minutes), delay between the completion of the anterior procedure and the start of the posterior procedure (11.8 vs. 69.5 minutes), and the incidence of complications related to the use of single-lung ventilation (0 vs. 14.8%)(P < 0.05). Patients in the prone group required less time on oxygen after surgery (34.8 vs. 51.6 hours) and were discharged home earlier (4.6 vs. 5.5 days) (P < 0.05). Conclusions. A thoracoscopic anterior spinal release and fusion in the prone position appears to achieve the same results as when performed in the lateral position for pediatric spinal deformity. The prone position saves time in the operating room due to decreasing the time needed by the anesthesiologists and the transition time between the anterior and posterior procedures. Potentially serious complications related to single-lung ventilation are avoided with bilateral-lung ventilation in the prone position.

KW - Pediatric spinal deformity

KW - Prone

KW - Respiratory complications

KW - Thoracoscopy

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