What are the anterior approach strategies in the surgical treatment of idiopathic scoliosis?

Updated: Dec 02, 2020
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Anterior scoliosis surgery involves three main strategies, as follows:

  • Anterior lumbar or thoracolumbar surgery through a retroperitoneal approach that may or may not involve a diaphragmatic incision
  • Anterior thoracic surgery via traditional open thoracotomy
  • Anterior thoracic surgery via VATS

Various factors relative to skeletal maturity, curve location, and curve flexibility help determine which (if any) of these anterior surgeries may be appropriate.

The most common reason to use the retroperitoneal approach is for an instrumented anterior thoracolumbar spinal fusion. The most common curve pattern in that particular type of scoliosis is an apex left curve pattern; accordingly, the patient is usually positioned lying on the right side. This position is advantageous in that it provides the best access to the scoliotic spine and also places the thick-walled aorta closer to the surgical field (as opposed to the thin-walled inferior vena cava).


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