Anterior debridement and reconstruction via thoracoscopy-assisted mini-open approach for the treatment of thoracic spinal tuberculosis: minimum 5-year follow-up
- 526 Downloads
Video-assisted thoracoscopic surgery (VATS) has been developed for surgical treatment of thoracic spinal tuberculosis to overcome the problems associated with a formal thoracotomy. VATS, however, is technically demanding with a difficult learning curve.
Materials and methods
We conducted a retrospective long-term follow-up study of anterior debridement and reconstruction via a thoracoscopy-assisted mini-open approach for the surgical treatment of thoracic spinal tuberculosis. There were 50 patients collected with mean age 38.3 years with thoracic spinal tuberculosis.
The average operative time was 210 min (range 170–300 min), the average blood loss during operation was 550 ml (range 300–1,000 ml), and the mean chest drainage duration was 3.5 days (3–5 days). Complications occurred in 17 patients (34%). The mean follow-up was 6.5 years. There was statistically difference in VAS 3 months after surgery compared to preoperatively (P < 0.001), as well as final follow-up compared to 3 months post-op (P < 0.001). In patients with minor pulmonary impairment as measured by pulmonary function testing, 15 improved to normal and 5 had no change. In patients with moderate pulmonary impairment, 6 improved to normal and 2 improved to minor impairment at final follow-up. Neurological improvement of one to three grades had occurred in 26 patients by final follow-up. There was statistically difference in kyphotic angle 3 months after surgery compared to preoperatively (P < 0.05), as well as final follow-up compared to 3 months post-op (P < 0.001). The average correction rate of kyphotic angle was 38.7% and the loss of correction rate was 1.3% at final follow-up. No recurrent tuberculosis was found.
Thoracoscopy-assisted mini-open approach can provide a simple, safe, and practical treatment option with minimal invasiveness in cases of thoracic spinal tuberculosis. Successful clinical and radiographic outcomes can be achieved via anterior debridement and reconstruction at long-term follow-up.
KeywordsSpinal thoracic vertebrae Thoracoscopy Tuberculosis
Conflict of interest
- 14.Kim YJ, Lenke LG, Bridwell KH, Cheh G, Sides B, Whorton J (2008) Prospective pulmonary function comparison of anterior spinal fusion in adolescent idiopathic scoliosis: thoracotomy versus thoracoabdominal approach. Spine (Phila Pa 1976) 33:1055–1060. doi: 10.1097/BRS.0b013e31816fc3a5 CrossRefGoogle Scholar
- 16.Levin R, Matusz D, Hasharoni A, Scharf C, Lonner B, Errico T (2005) Mini-open thoracoscopically assisted thoracotomy versus video-assisted thoracoscopic surgery for anterior release in thoracic scoliosis and kyphosis: a comparison of operative and radiographic results. Spine J 5:632–638PubMedCrossRefGoogle Scholar
- 18.McAfee PC, Regan JR, Zdeblick T, Zuckerman J, Picetti GD 3rd, Heim S, Geis WP, Fedder IL (1995) The incidence of complications in endoscopic anterior thoracolumbar spinal reconstructive surgery. A prospective multicenter study comprising the first 100 consecutive cases. Spine (Phila Pa 1976) 20:1624–1632CrossRefGoogle Scholar
- 20.Ozdemir HM, Us AK (2003) The role of anterior spinal instrumentation and allograft fibula for the treatment of Pott disease. Spine (Phila Pa 1976) 28:474–479Google Scholar