Selective Anterior Thoracic Instrumentation & Fusion
Case Presentation: AR is a 15-year-old who presents with a double major scoliosis. Right
thoracic curve measures 65, left lumbar curve measures 58. Significant structural changes were
identified in the right thoracic curve. The left lumbar curve demonstrated significant flexibility
on side bending.
Surgical Procedure: Options for treatment include standard posterior stabilization and fusion
extending from T4-L4. A second and more attractive option would include a selective thoracic
fusion addressing the primary right thoracic curve. A secondary correction of the lumbar curve
may be expected based on previous experience gained in Europe and in Japan. 1,2,3,4,5.
The patient underwent surgical intervention which included right thoracotomy, removal of the
discs from T6-T11, insertion of screws, and correction with a 5 mm rod utilizing the Moss-Miami
system. Fusion cages were utilized at the lower segment to maintain appropriate alignment at
this level. A thoracoplasty was performed. This involves removal of short segments of rib to
alleviate the rib hump. Postoperative radiographs reveal a substantial correction of the right
thoracic curve and a spontaneous improvement of the lumbar curve.
Preoperative Requirements: Autologous blood donation (2-3 units) with concurrent
supplemental Ferrous Sulfate and MVI. Current spinal x-rays, screening blood, and urine tests,
AP and lateral chest x-rays, and pulmonary function tests.
Anticipated Postoperative Course: One night in the PICU. Five days in the hospital. Three or
four weeks off of school. Custom molded TLSO worn when out of bed for approximately four
months. No gym or sports for six months. Usually patients are off of all narcotic pain medication
after four weeks. Most patients resume all normal activities by six months postop.
Discussion: The development of the selective anterior thoracic technique can be credited to Dr.
Klaus Zielke, from Germany. The current surgical procedure is similar to that used by Dr. Zielke.
Advances in spinal instrumentation appear to have improved fusion rates and sagittal spinal
alignment. The selective thoracic fusion may be performed from the posterior approach but
problems with coronal plane decompensation have been reported. The selective anterior
thoracic fusion technique offers a major long-term benefit to the patient and the lumbar spine
remains un-fused. This should allow for greater spinal mobility and should decrease the long
term risk of accelerated spinal degeneration adjacent to instrumentation extending into the
lumbar spine.
*See Below for Preoperative and Postoperative X-rays*
Pre-Operative PA & Lateral Radiographs
Pre-Operative Bending Radiographs
Post-Operative Radiographs