Anterior debridement and reconstruction via thoracoscopy-assisted mini-open approach for the treatment of thoracic spinal tuberculosis: minimum 5-year follow-up

摘要

IntroductionVideo-assisted thoracoscopic surgery (VATS) has been developed for surgical treatment of thoracic spinal tuberculosis to overcome the problems associated with a formal thoracotomy. VATS, however, is technically demanding with a difficult learning curve.Materials and methodsWe conducted a retrospective long-term follow-up study of anterior debridement and reconstruction via a thoracoscopy-assisted mini-open approach for the surgical treatment of thoracic spinal tuberculosis. There were 50 patients collected with mean age 38.3?years with thoracic spinal tuberculosis.ResultsThe average operative time was 210?min (range 170–300 min), the average blood loss during operation was 550?ml (range 300–1,000?ml), and the mean chest drainage duration was 3.5?days (3–5?days). Complications occurred in 17 patients (34%). The mean follow-up was 6.5?years. There was statistically difference in VAS 3?months after surgery compared to preoperatively (P??0.001), as well as final follow-up compared to 3?months post-op (P??0.001). In patients with minor pulmonary impairment as measured by pulmonary function testing, 15 improved to normal and 5 had no change. In patients with moderate pulmonary impairment, 6 improved to normal and 2 improved to minor impairment at final follow-up. Neurological improvement of one to three grades had occurred in 26 patients by final follow-up. There was statistically difference in kyphotic angle 3?months after surgery compared to preoperatively (P??0.05), as well as final follow-up compared to 3?months post-op (P??0.001). The average correction rate of kyphotic angle was 38.7% and the loss of correction rate was 1.3% at final follow-up. No recurrent tuberculosis was found.ConclusionThoracoscopy-assisted mini-open approach can provide a simple, safe, and practical treatment option with minimal invasiveness in cases of thoracic spinal tuberculosis. Successful clinical and radiographic outcomes can be achieved via anterior debridement and reconstruction at long-term follow-up...