Video-assisted thoracoscopic surgery in managing tuberculous spondylitis

The literature includes no studies on the use of video-assisted thoracoscop ic surgery in the management of tuberculous spondylitis, and its role in th e management of tuberculosis involving the thoracic spine remains unclear. The authors experience with 10 consecutive patients (six women, four men) w ho underwent video-assisted thoracoscopic surgery for the treatment of spin al tuberculosis involving levels from T5 to T11, from January 1996 to Decem ber 1997, was analyzed. Using the extended manipulating channel method (2.5 -3.5 cm portal incisions), video-assisted thoracoscopic surgery was perform ed with a three-portal technique (seven patients) or a modified two-portal minithoracotomy technique that required a small incision for the thoracosco pe and a larger incision, measuring 5 to 6 cm, for the procedures in three patients. All the patients were studied prospectively, The followup ranged from 17 to 42 months (mean, 24 months). Postoperative complications include d one lung atelectasis, Pleural adhesions, owing to local inflammation or p aravertebral abscess, were seen in four patients and one patient with sever e pleurodesis needed an open technique for treatment. Postoperative air lea ks were seen in four (40%) of 10 patients but all were transient. The avera ge neurologic recovery was 1.1 grades on the Frankel's scale. The data from this series of patients with tuberculous spondylitis show that video-assis ted thoracoscopic surgery has diagnostic and therapeutic roles in the manag ement of tuberculous spondylitis. Technically, a combination of thoracoscop y and conventional spinal instruments to perform video-assisted thoracoscop ic surgery through the extended manipulating channels, which were placed sl ightly more posterior than usual, was effective and safe.