Thoracoscopic decompression in Pott's spine and its long-term follow-up.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, ESI Basai Darapur, New Delhi, India.
Sudhir
S
Kapoor
Saurabh
S
Kapoor
Mayank
M
Agrawal
Pankaj
P
Aggarwal
Brijesh Kumar
BK
Jain
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003646:Debridement / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000601:surgery*; D055815:Young Adult