Advertisement

European Spine Journal

, Volume 21, Issue 3, pp 463–469 | Cite as

Anterior debridement and reconstruction via thoracoscopy-assisted mini-open approach for the treatment of thoracic spinal tuberculosis: minimum 5-year follow-up

  • Guohua Lü
  • Bing Wang
  • Jing Li
  • Weidong Liu
  • Ivan Cheng
Original Article

Abstract

Introduction

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.

Results

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.

Conclusion

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.

Keywords

Spinal thoracic vertebrae Thoracoscopy Tuberculosis 

Notes

Conflict of interest

None.

References

  1. 1.
    Akgül AG, Örki A, Örki T, Yüksel M, Arman B (2011) Approach to empyema necessitatis. World J Surg 35:981–984. doi: 10.1007/s00268-011-1035-5 Google Scholar
  2. 2.
    Pearson MG, Alderslade R, Allen SC et al (1997) BTS guidelines for the management of chronic obstructive pulmonary disease. The COPD Guidelines Group of the Standards of Care Committee of the BTS. Thorax 52:S1–S28CrossRefGoogle Scholar
  3. 3.
    Dai LY, Jiang LS, Wang W, Cui YM (2005) Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976) 30:2342–2349. doi: 10.1097/01.brs.0000182109.36973.93 CrossRefGoogle Scholar
  4. 4.
    Dickman CA, Rosenthal D, Karahalios DG, Paramore CG, Mican CA, Apostolides PJ, Lorenz R, Sonntag VK (1996) Thoracic vertebrectomy and reconstruction using a microsurgical thoracoscopic approach. Neurosurgery 38:279–293PubMedCrossRefGoogle Scholar
  5. 5.
    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) 20:1592–1599CrossRefGoogle Scholar
  6. 6.
    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 48:172–178PubMedCrossRefGoogle Scholar
  7. 7.
    Huang TJ, Hsu RW, Chen SH, Liu HP (2000) Video-assisted thoracoscopic surgery in managing tuberculous spondylitis. Clin Orthop Relat Res 379:143–153PubMedCrossRefGoogle Scholar
  8. 8.
    Ha KY, Chung YG, Ryoo SJ (2005) Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants. Spine (Phila Pa 1976) 30:38–43. doi: 10.1097/01.brs.0000147801.63304.8a CrossRefGoogle Scholar
  9. 9.
    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. doi: 10.1007/s004649900987 PubMedCrossRefGoogle Scholar
  10. 10.
    Ikard RW (2006) Methods and complications of anterior exposure of the thoracic and lumbar spine. Arch Surg 141:1025–1034PubMedCrossRefGoogle Scholar
  11. 11.
    Jayaswal A, Upendra B, Ahmed A, Chowdhury B, Kumar A (2007) Video-assisted thoracoscopic anterior surgery for tuberculous spondylitis. Clin Orthop Relat Res 460:100–107PubMedGoogle Scholar
  12. 12.
    Jin D, Qu D, Chen J, Zhang H (2004) One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J 13:114–121. doi: 10.1007/s00586-003-0661-5 PubMedCrossRefGoogle Scholar
  13. 13.
    Kapoor SK, Agarwal PN, Jain BK Jr, Kumar R (2005) Video-assisted thoracoscopic decompression of tubercular spondylitis: clinical evaluation. Spine (Phila Pa 1976) 30:E605–E610. doi: 10.1097/01.brs.0000182328.03082.e2 CrossRefGoogle Scholar
  14. 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
  15. 15.
    Kossmann T, Jacobi D, Trentz O (2001) The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine. Eur Spine J 10:396–402. doi: 10.1007/s005860100330 PubMedCrossRefGoogle Scholar
  16. 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
  17. 17.
    Moon MS (1997) Tuberculosis of the spine. Controversies and a new challenge. Spine (Phila Pa 1976) 22:1791–1797CrossRefGoogle Scholar
  18. 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
  19. 19.
    Mückley T, Schütz T, Schmidt MH, Potulski M, Bühren V, Beisse R (2004) The role of thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 29:E227–E233CrossRefGoogle Scholar
  20. 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
  21. 21.
    Regan JJ, Guyer RD (1997) Endoscopic techniques in spinal surgery. Clin Orthop Relat Res 335:122–139PubMedGoogle Scholar
  22. 22.
    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 302:173–182PubMedGoogle Scholar
  23. 23.
    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. doi: 10.1007/s00776-006-1086-x PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Guohua Lü
    • 1
  • Bing Wang
    • 1
  • Jing Li
    • 1
  • Weidong Liu
    • 1
  • Ivan Cheng
    • 2
  1. 1.Department of Spine SurgerySecond Xiangya Hospital of Central South UniversityChangshaChina
  2. 2.Department of Orthopaedic SurgeryStanford UniversityStanfordUSA

Personalised recommendations