Master’s Surgical Technique: Anterior Solid Dual-Rod Instrumentation and Fusion for Flexible Thoracolumbar or Lumbar Spinal Deformities in Adolescent Idiopathic Scoliosis

Background Anterior spinal instrumentation and fusion (ASIF) via a thoracolumbar approach has been used to treat Lenke 5 adolescent idiopathic scoliosis (AIS) for decades. Advances in ASIF technique and instrumentation have yielded significant improvements in rates of instrumentation failure, need for reoperation, instrumented and adjacent segment kyphosis, and pseudarthrosis. Despite reports of ASIF success using these strategies, a detailed technical description with illustrations of this procedure in the literature is lacking. Purpose We present a detailed surgical technique guide for anterior solid-rod instrumentation via a thoracoabdominal approach in the correction of a Lenke 5 AIS deformity. Summary Anterior spinal instrumentation and fusion through a thoracoabdominal approach allows for excellent coronal and axial correction of the primary structural curve while possibly instrumenting fewer vertebrae and sparing the paraspinal muscles compared to posterior instrumented fusion. This is especially appealing to adolescent athletes who want to preserve spine mobility, as fusion of fewer spine segments may provide more physiologic functional mobility of the spine. Transiently lowered pulmonary function due to the incision and repair of the diaphragm is expected. Pitfalls to avoid include leaving unrepaired peritoneal holes, improper detachment and repair of the diaphragm, injury to the genitofemoral nerve, violating the spinal canal with screws, fusing too few segments, screw pullout in osteopenic bone, and irritation of the intercostal nerve. Conclusion We describe the indications for anterior instrumented fusion, pre-