Analysis of the STIF technique for spino-pelvic fixation: clinical results in 19 patients with neuromuscular scoliosis.

The STIF (spinopelvic transiliac fixation) technique for lumbosacral fusion was developed by the authors as an alternative to the Luque-Galveston technique. The results observed in this initial series of 27 neuromuscular scoliosis patients treated with the STIF technique are reported. With a minimum of 24 months of radiographic follow-up in 19 patients, the percentage of correction of scoliosis curvature and pelvic obliquity was superior to that reported in the literature. The rates of complications and pseudarthrosis in this series are typical for this patient population. The STIF technique facilitates compression across the sacroiliac joints, which promotes sacroiliac joint fusion and can provide a stable base for curvature correction and lumbosacral fusion. Despite the severe coronal and sagittal plane curves in this group of patients, total operative time also compares favorably to that reported in the literature. The STIF technique requires a well-developed posterior iliac apophysis, which may not be present in younger pediatric patients.

Video-assisted thoracoscopic surgery in the prone position.

STUDY DESIGN: Review of 27 consecutive patients who underwent video-assisted thoracoscopic surgery (VATS) in the prone position for anterior release and discectomy. OBJECTIVES: To convey the benefits and safety of this new technique for treating spinal deformities through VATS. SUMMARY OF BACKGROUND DATA: All reports using VATS for spinal deformities describe the patient in the lateral position. This is the first study to demonstrate the benefits and safety of the prone position. METHODS: The patient is positioned prone, prepared, and draped allowing room for lateral portals on the convexity of the curve. Traditionally, a double-lumen endotracheal tube is used to deflate the ipsilateral lung. Prone positioning eliminates this need, because gravity aids in retraction of the lung. RESULTS: All procedures were successfully performed using the VATS technique with the patient prone. After the anterior release and discectomy, posterior instrumentation (n = 27), costoplasty (n = 16), and fusion (n = 27) were performed. The time (n = 20) and blood loss (n = 16) for the anterior approach averaged 129 +/- 35 minutes and 221 +/- 231 mL, respectively. The mean number of disks resected was 3.3 +/- 0.7 (range, 2-5). CONCLUSION: The prone position is both safe and effective for VATS when treating spinal deformity. The current results confirm that there is no need to insert a double-lumen tube, there is gravity-assisted correction of kyphosis when the patient is prone, and significant operative time is saved with the elimination of repositioning and redraping before the posterior procedure. Surgical times and blood loss compare very favorably with those reported for VATS in the lateral position.