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

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.

Video-Assisted Thoracic Surgery for Tubercular Spondylitis

“…The decompression was adequate as indicated by the neurological recovery in all our cases. Our results are in accordance with available literature showing neurological recovery varying from 82 to 95% recovery of ambulatory status [12,13,[15][16][17]. In a retrospective study done by Jayaswal et al (2007), postoperatively 17 of the 18 patients with preoperative neurologic deficit attained ambulatory status and all patients showed improvement on the Frankel scale, with Grade C in one patient, Grade D in 10 patients, and Grade E in 12 patients [12].…”

“…Huang et al (2000) in their study of 10 patients followed for 24 months reported results as excellent ( = 4), good ( = 5), or fair ( = 1) [15]. In a series by Kapoor et al (2012), out of 30 patients, excellent results were obtained in 24 patients, good in four, and fair in two, with 95% of patients having a good or excellent result [13].…”

“…In a series by Kapoor et al decompression after 10 weeks [16]. In another series of 30 patients by Kapoor et al (2012), all patients improved neurologically on a mean followup of 80 months. No patient had neurological deterioration and all of them regained ambulatory power with no cases of recurrence of tuberculosis [13].…”

“…In another series of 30 patients by Kapoor et al (2012), all patients improved neurologically on a mean followup of 80 months. No patient had neurological deterioration and all of them regained ambulatory power with no cases of recurrence of tuberculosis [13]. In a series by Huang et al (2000), after a followup of 24 months, the average neurologic recovery was 1.1 grades on Frankel's scale [15].…”

“…(2012) reported a statistically significant difference ( < 0.001 with Student's -test) in VAS for back pain at three months compared to the preoperative period and at five-year followup compared to three months ( < 0.001) [13].…”