Video-Assisted Thoracoscopic Decompression of Tubercular Spondylitis: Clinical Evaluation

Kapoor, Satwanti; Agarwal, Prakash; Jain, Brijesh Kumar; Kumar, Rakesh

doi:10.1097/01.brs.0000182328.03082.e2

Cited by 33 publications

(38 citation statements)

References 8 publications

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“…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].…”

Section: Discussionsupporting

confidence: 80%

Video-Assisted Thoracic Surgery for Tubercular Spondylitis

Singh

2017

Tuberculosis of the Central Nervous System

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The present study evaluated the outcome of video-assisted thoracic surgery (VATS) in 9 patients (males = 6, females = 3) with clinico-radiological diagnosis of tubercular spondylitis of the dorsal spine. The mean duration of surgery was 140.88 ± 20.09 minutes, mean blood was 417.77 ± 190.90 mL, and mean duration of postoperative hospital stay was 5.77 ± 0.97 days, Seven patients had a preoperative Grade A neurological involvement, while at the time of final followup the only deficit was Grade D power in 2 patients. In patients without bone graft placement (n = 6), average increase in Kyphosis angle was 16 ∘ , while in patients with bone graft placement (n = 3) the deformity remained stationary. At the time of final follow up, fusion was achieved in all patients, the VAS score for back pain improved from a pretreatment score of 8.3 to 2, and the function assessment yielded excellent (n = 4) to good (n = 5) results. In two patients minithoracotomy had to be resorted due to extensive pleural adhesions (n = 1) or difficulty in placement of graft (n = 1). Videoassisted thoracoscopic surgery provides a safe and effective approach in the management of spinal tuberculosis. It has the advantages of decreased blood loss and post operative morbidity with minimal complications.

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Section: Discussionsupporting

confidence: 80%

Video-Assisted Thoracic Surgery for Tubercular Spondylitis

Singh

2017

Tuberculosis of the Central Nervous System

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“…All the complications of conventional thoracotomy are still possible with the VATS procedure with a reported rate of 24.4-31.3% [12,24,25]. In our series, pulmonary complications were seen in 20% of cases.…”

Section: Discussionmentioning

confidence: 55%

“…In tuberculosis, since the compression is anterior, it is logical to decompress the spinal cord via the anterior approach. VATS can also be a useful alternative to conventional thoracotomy in TB of dorsal spine [11,12] to avoid potentially delayed rehabilitation caused by postoperative pain and complications [16] of thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

“…VATS has been used extensively in spinal deformities such as scoliosis with results comparable to open procedures, but there has been limited use of VATS for decompression in active tuberculosis of dorsal spine [10][11][12]. The senior author (SK) has reported his early clinical results and good outcome in the past [12]. We now report 30 cases of dorsal spinal tuberculosis with a minimum five-years of follow-up who underwent anterior debridement via the VATS approach to assess the effectiveness of this technique with which we were able to achieve adequate decompression of the cord leading to neurological recovery and good healing of disease in all the cases.…”

Section: Introductionmentioning

confidence: 99%

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

Kapoor

Agrawal

et al. 2012

International Orthopaedics (SICOT)

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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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Neurological recovery and efficacy of posterior per‐cutaneous pedicle internal fixation combined with full‐endoscopic debridement and intravertebral bone grafting in the treatment of thoracolumbar tuberculosis

Wang

Yuan

et al. 2020

Ibrain

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Background:The traditional open surgery in the treatment of spinal tuberculosis has the disadvantages of greater trauma, with more intraoperative bleeding and long postoperative hospitalization days. With the development of minimally invasive spine surgery (MISS) and spinal endoscopic systems, the minimally invasive spine surgery technique was increasingly being used by surgeons because it minimizes trauma, and patients experience faster recovery. The purpose of this study was to discuss the eicacy and clear indications of this treatment. Methods:The clinical data of thirty-one patients with thoracolumbar tuberculosis treated by posterior percutaneous pedicle screw fixation combined with full-endoscopic debridement and intravertebral bone grafting were analyzed retrospectively. The preoperative and postoperative imaging manifestations and clinical results were compared, and the postoperative complications were observed with a follow-up for more than 1 year. Results: Compared with values before the operation, the visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score were signiicantly decreased at 3 months after operation and at the last follow-up. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were decreased at 3 months after surgery and at the last follow-up, and no signiicant reduction was observed in the Cobb angle at 3 months after operation or at the last follow-up. In addition, imaging examinations showed that the necrotic material in vertebral bodies was adequately resected. Conclusion: One-stage percutaneous pedicle screw ixation combined with full-endoscopic focus debridement and intravertebral bone grafting can achieve the purpose of removing the focus of thoracolumbar tuberculosis, restoring neurological function, and reconstructing spinal stability. It was a safe and feasible surgical method and its surgical indications were clariied.

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Video-Assisted Thoracoscopic Decompression of Tubercular Spondylitis: Clinical Evaluation

Abstract: Video-assisted thoracoscopic decompression of tubercular dorsal spondylitis is a viable option to achieve significant neurologic recovery with less morbidity, blood requirement, and hospital stay compared to the open thoracotomy procedures.

Cited by 33 publications

References 8 publications

Video-Assisted Thoracic Surgery for Tubercular Spondylitis

Video-Assisted Thoracic Surgery for Tubercular Spondylitis

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

Neurological recovery and efficacy of posterior per‐cutaneous pedicle internal fixation combined with full‐endoscopic debridement and intravertebral bone grafting in the treatment of thoracolumbar tuberculosis

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