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Thoracoscopic decompression in Pott’s spine and its long-term follow-up

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Abstract

Purpose

Video-assisted thoracoscopic surgery (VATS) has become an alternative tool for a variety of spinal conditions as this approach minimises much morbidity related to conventional thoracotomy. The purpose of this study was to determine the efficacy of VATS and its long-term results in patients with dorsal spinal tuberculosis.

Materials and methods

This retrospective long-term follow-up study of VATS-assisted surgical treatment of dorsal spine tuberculosis included 30 patients with a mean age of 33.5 years (range 15–60). Patients with dorsal spine tuberculosis who were suitable surgical candidates for VATS underwent a three-portal thoracoscopy for decompression with/without fusion of the spine along with routine chemotherapy for tuberculosis (TB). Patients were assessed for blood loss, duration of surgery, postoperative incision pain, duration of hospital stay, neurological recovery, and progression of deformity. Patients were observed for a minimum of five years.

Results

The mean duration of surgery was 158.8 min (range 90–220 min) with mean blood loss of 296.7 ml (range 200–450 ml). Complications were seen in ten patients. The mean follow-up was 80 months (range 60–90 months) with neurological improvement and return of ambulatory power in all patients at final follow-up. There was an average increase in kyphus angle by 7.5° at final follow-up and 95% of patients achieved an excellent or good subjective outcome.

Conclusion

VATS-assisted surgical decompression can be a safe and effective technique for anterior debridement and fusion in tuberculosis of the dorsal spine to achieve neurological recovery with reduced morbidity, blood loss, and hospital stay compared to thoracotomy.

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References

  1. World Health Organization (2008) Global tuberculosis control: surveillance, planning, financing. Publication no. WHO/HTM/TB/ 2008.393. World Health Organization, Geneva, Switzerland

  2. Tuli SM (1975) Results of treatment of spinal tuberculosis by “middle-path” regime. J Bone Joint Surg 57B:13–23

    Google Scholar 

  3. Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of spine treated by anterior arthrodesis. J Bone Joint Surg Am 71:1314–1323

    PubMed  CAS  Google Scholar 

  4. Hodgson AR, Stock FE, Fang HS, Ong GB (1960) Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott’s disease of the spine. Br J Surg 48:172–178

    Article  PubMed  CAS  Google Scholar 

  5. Upadhyay SS, Sell P, Saji MJ, Sell B, Hsu LC (1994) Surgical management of spinal tuberculosis in adults. Hong Kong operation compared with debridement surgery for short and long term outcome of deformity. Clin Orthop Relat Res 302:173–182

    PubMed  Google Scholar 

  6. Amini A, Beisse R, Schmidt MH (2005) Thoracoscopic spine surgery for decompression and stabilization of the anterolateral thoracolumbar spine. Neurosurg Focus 19:E4

    PubMed  Google Scholar 

  7. Ikard RW (2006) Methods and complications of anterior exposure of the thoracic and lumbar spine. Arch Surg 141:1025–1034

    Article  PubMed  Google Scholar 

  8. Newton PO, Marks M, Faro F, Betz R, Clements D, Haher T, Lenke L, Lowe T, Merola A, Wenger D (2003) Use of video assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery. Spine 28:S249–S254

    Article  PubMed  Google Scholar 

  9. Crawford AH (2005) Anterior surgery in the thoracic and lumbar spine: endoscopic techniques in children. Instr Course Lect 54:567–576

    PubMed  Google Scholar 

  10. Dusmet M, Halkic N, Corpataux JM (1999) Video assisted thoracic surgery diagnosis of thoracic spinal tuberculosis. Chest 116:1471–1472

    Article  PubMed  CAS  Google Scholar 

  11. Huang TJ, Hsu RW, Chen SH, Liu HP (2000) Video-assisted thoracoscopic surgery in managing tuberculous spondylitis. Clin Orthop Relat Res 379:143–153

    Article  PubMed  Google Scholar 

  12. Kapoor SK, Agarwal PN, Jain BK Jr, Kumar R (2005) Videoassisted thoracoscopic decompression of tubercular spondylitis: clinical evaluation. Spine (Phila Pa 1976) 30:E605–E610

    Article  Google Scholar 

  13. Griffiths DL, Seddon HJ, Roaf R (1956) Pott’s paraplegia. Oxford University Press, London

  14. Regan JJ (1997) Endoscopic spine surgery. In: Frymoyer J et al. (eds) The adult spine: principle and practice. Raven, Philadelphia, pp 1665–1684

  15. Huang TJ, Hsu RW, Liu HP, Liao YS, Shih HN (1997) Technique of video assisted thoracoscopic surgery for the spine: new approach. World J Surg 21:358–362

    Article  PubMed  CAS  Google Scholar 

  16. Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L (1995) The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine (Phila Pa 1976) 20:1592–1599

    Article  CAS  Google Scholar 

  17. Louw JA (1990) Spinal tuberculosis with neurological defect: treatment with anterior vascularised rib grafts, posterior osteotomies and fusion. J Bone Joint Surg Br 72:686–693

    PubMed  CAS  Google Scholar 

  18. Jain AK, Aggarwal A, Dhammi IK, Aggarwal PK, Singh S (2004) Extrapleural anterolateral decompression in tuberculosis of the dorsal spine. J Bone Joint Surg Br 86:1027–1031

    Article  PubMed  CAS  Google Scholar 

  19. Medical Research Council (1982) A 10 year assessment of a controlled trial comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in Hong Kong: Eighth report of the Medical Research Council working party on the tuberculosis of the spine. J Bone Joint Surg Br 64:393–398

    Google Scholar 

  20. Laheri VJ, Badhe NP, Dewnany GT (2001) Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculosis kyphosis of the dorsolumbar spine. Spinal Cord 39:429–436

    Article  PubMed  CAS  Google Scholar 

  21. Landerneau RJ, Hazelrigg SR, Mack MJ et al (1993) Postoperative pain related morbidity: Video assisted thoracic surgery versus thoracotomy. Ann Thorac Surg 56:1285–1289

    Article  Google Scholar 

  22. Mangione P, Vadier F, Senegas J (1999) Thoracoscopy versus thoracotomy in spinal surgery: comparison of two paired series. Rev Chir Orthop Repratrice Appar Mot 85:574–580

    CAS  Google Scholar 

  23. Lu G, Wang B, Li J, Liu W, Cheng I (2011) Anterior debridement and reconstruction via thoracoscopy assisted mini-open approach for the treatment of thoracic spinal tuberculosis: minimum 5-year follow-up. Eur Spine J. Oct 14 [Epub ahead of print]

  24. Huang TJ, Hsu RW, Sum CW, Liu HP (1999) Complications in thoracoscopic spinal surgery: a study of 90 consecutive patients. Surg Endosc 13:346–350

    Article  PubMed  CAS  Google Scholar 

  25. Watanabe K, Yabuki S, Konno S, Kikuchi S (2007) Complications of endoscopic spinal surgery: a retrospective study of thoracoscopy and retroperitoneoscopy. J Orthop Sci 12:42–48

    Article  PubMed  Google Scholar 

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Conflict of interest statement

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, ESI Basai Darapur, New Delhi, India

    Sudhir Kapoor

  2. Department of Orthopaedics, Maulana Azad Medical College New Delhi, Delhi, India

    Saurabh Kapoor & Pankaj Aggarwal

  3. Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany

    Mayank Agrawal

  4. Specialist Orthopaedics, Delhi Government, New Delhi, India

    Brijesh Kumar Jain Jr.

  5. 34 Madhuban Enclave, Mathura, UP, India

    Mayank Agrawal

Authors
  1. Sudhir Kapoor
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  2. Saurabh Kapoor
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  3. Mayank Agrawal
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  4. Pankaj Aggarwal
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  5. Brijesh Kumar Jain Jr.
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Correspondence to Mayank Agrawal.

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Kapoor, S., Kapoor, S., Agrawal, M. et al. Thoracoscopic decompression in Pott’s spine and its long-term follow-up. International Orthopaedics (SICOT) 36, 331–337 (2012). https://doi.org/10.1007/s00264-011-1453-x

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  • DOI: https://doi.org/10.1007/s00264-011-1453-x

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