Video-assisted Thoracoscopic Anterior Surgery for Tuberculous Spondylitis

Abstract

In the absence of major deformity, the major goal of surgery in tuberculous spondylitis is to achieve adequate cord decompression and débridement of diseased tissue. We asked whether video-assisted thoracoscopic surgery (VATS) could be undertaken in active tuberculosis of the spine with instrumentation and achieve good healing of the disease with fusion and with adequate decompression of the cord to achieve neural recovery. We retrospectively reviewed 23 patients (13 men and 10 women with an average age of 38.2 years) with single-level thoracic spinal tuberculosis (T4-T11) treated with VATS. Of the 23 patients, 18 had paraparesis/paraplegia. The procedures included: (1) débridement and drainage of prevertebral and paravertebral abscess (n = 4); (2) débridement, decompression, and reconstruction with rib graft (n = 8); (3) débridement, decompression, anterior vertical titanium mesh cage, and open posterior screw-rod fixation (n = 5); and (4) débridement, decompression, and anterior screw-rod fixation (n = 6). Twenty-two of 23 patients achieved fusion and there was no recurrence of the disease in any of the patients. No patient had neurological deterioration and 17 of the 18 neurologically compromised patients regained ambulatory power. Small scars (for surgical portals), early mobilization, and short hospital stays were the salient advantages.

Video-Assisted Thoracic Surgery for Tubercular Spondylitis

“…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]. In a series by Kapoor et al decompression after 10 weeks [16].…”

“…In our study, the mean preoperative, postoperative, 6-month, and 12-month kyphosis angle in patients without bone graft placement were 25 ∘ , 32 ∘ , and 41 ∘ , respectively. Therefore, final X-ray examination revealed an average ∘ and 31 ∘ in patients in whom reconstruction with bone graft was done [12]. In a series by Huang et al (2000), the mean preoperative, postoperative, and 2-year follow-up kyphosis angles were 26.8 ∘ , 16.8 ∘ , and 26 ∘ , respectively [15].…”

“…There is a steep learning curve before all the surgical goals of the open method can be attained through VATS. Adequate hand and eye coordination, which is necessary to perform remote bone and soft tissue dissection and to establish proper orientation under the angled endoscope, is required [12,13,[15][16][17]. However, the strength of the study is that it is a single institutional study with cases operated by the same team of surgeons.…”

“…In a series of 23 patients who underwent VATS by Jayaswal et al (2007), 22 achieved fusion with an average time for fusion of 16.5 weeks. Sixteen patients had Grade I fusion and six had Grade II fusion, and failure of fusion was seen in one patient [12].…”

“…In a series of 23 patients who underwent VATS by Jayaswal et al (2007), 22 achieved fusion with an average time for fusion of 16.5 weeks. Sixteen patients had Grade I fusion and six had Grade II fusion, and failure of fusion was seen in one patient [12]. In a series by Kandwal et al (2012), 22 of 23 patients who underwent VATS had good fusion (Grade I and Grade II) and there was failure of fusion in one patient [17].…”