ABSTRACT
Video-assisted thoracoscopy has recently evolved as an effective technique for multilevel anterior thoracic release and fusion in the treatment of spinal deformity. This minimally invasive approach was reintroduced in the early 1990s and has since become the standard approach to the anterior thoracic spine at many medical centers. In patients with scoliosis, anterior release and fusion is generally indicated for the treatment of large or rigid curves that require increased flexibility to obtain maximal correction during posterior instrumentation and fusion. Primarily, any medical history of compromised pulmonary status or intrathoracic pleural adhesion formation secondary to a prior thoracotomy or pulmonary infection should be considered a relative contraindication. Curves in which the spine has become closely approximated to the rib cage may be another relative contraindication due to the necessity of an adequate working space. The necessary number of ports is dictated mainly by the deformity being treated and the number of levels that require treatment.
