Area of Focus: Pediatric Orthopaedics

Describes video-assisted thoracoscopic surgery (VATS) that has become an accepted alternative approach to the thoracic spine for release of disc space contents with or without fusion. The technique can be used for anterior spinal release, bone grafting of the inter-vertebral space, biopsy, removing benign tumors, or inserting implants. Thoracoscopy involves surgical access to the spine via several small incisions that are 1.0 to 2.5 cm in length. Through these incisions, a muscle splitting technique allows placement of soft or rigid trochars (ports) through which instruments can be inserted. Traditional thoracotomy requires a long incision with extensive dissection of muscles. There is rib resection with significant spreading of the intercostals spaces and tissue dissection. Limited visibility to the upper vertebrae is typical. The extensive thoracotomy incision may result in an alteration of pulmonary and shoulder girdle function. The goal of the endoscopic surgery presented in this program is to perform the same operations as the classical open techniques, but with less invasive methods.