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Upper Extremity Functional Assessment After Anterior Spinal Fusion via Thoracotomy for Adolescent Idiopathic Scoliosis: Prospective Study of Twenty-Five Patients

Burd, Timothy A., MD,*; Pawelek, Linda, OTR/L,†; Lenke, Lawrence G., MD


Study Design.  A prospective review of upper extremity function in 25 patients after anterior thoracotomy for instrumentation and fusion of thoracic adolescent idiopathic scoliosis was conducted.

Objective.  To assess the effects of anterior spinal fusion with open thoracotomy on upper extremity function.

Summary of Background Data.  The treatment of idiopathic scoliosis through anterior thoracotomy and spinal fusion using instrumentation is a new method for correcting and stabilizing patients with major thoracic and thoracolumbar curves. No studies have assessed the functional outcome for the upper extremities after anterior open thoracotomy that involves splitting through the latissimus dorsi and serratus anterior muscles.

Methods.  For this study, 25 adolescent patients with idiopathic scoliosis treated surgically were examined over a 3-year period. The average patient age was 15 years and 3 months, with a range of 11 years and 11 months to 20 years and 9 months. Preoperative activities of daily living, active range of motion, and strength were recorded by an independent occupational therapist (L.P.) for both upper extremities. Postoperative measurements were assessed at 1, 3, 6, 12, and 24 months. All the patients underwent a right thoracotomy with ribs used for autograft. The left upper extremity served as the control limb. No patients had associated anomalies or previous upper extremity surgery. All the patients underwent an upper extremity postoperative stretching and strengthening protocol.

Results.  At 1 month, 35% of the patients had some difficulty with activities of daily living, primarily in tying their shoes and cutting meat with a knife during meals (P = 0.03). However, by 3 months, all the patients could equivocally and independently perform activities of daily living: dressing, bathing, grooming, attending to hygiene, and feeding (P = 1). Full active range of motion in their upper extremities and shoulder was achieved in all the patients by 1 month (P = 1). All 25 patients had regained normal, bilaterally symmetric strength by 3 months (P = 0.25). No postoperative complications occurred.

Conclusions.  Patients undergoing anterior spinal fusion with instrumentation after open thoracotomy can expect to regain full function of the ipsilateral upper extremity in terms of strength, active range of motion, and activities of daily living within 3 months. Compliance with a structured postoperative flexibility and strengthening protocol is recommended to optimize functional outcomes. A novel rehabilitation protocol for the upper extremities is presented.

From the *University of Missouri Hospital and Clinics, Department of Orthopaedic Surgery, Columbia, Missouri, the

†Shriners Hospital for Children, Department of Occupational Therapy, Saint Louis, Missouri, and the

‡Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri.

Investigation performed at Shriners Hospital for Children, St. Louis, Missouri.

Acknowledgment date: November 3, 2000.

First revision date: April 18, 2001.

Acceptance date: June 4, 2001.

Device status category: 11.

Conflict of interest category: 12.

Address reprint requests to

Lawrence G. Lenke, MD

Department of Orthopaedic Surgery

WA University School of Medicine

One Barnes-Jewish Plaza, Suite 11300

St. Louis, MO 63110


© 2002 Lippincott Williams & Wilkins, Inc.