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Tubercular spondylitis thoracic spine (D10-D11). Patient had a good subjective outcome and all changes in laboratory and radiological (MRI, CT, and X-rays) parameters showed improvement by the end of 12 months. Fusion was achieved at 12 months. No complications were seen and sinus which was present at initial presentation completely healed at her 18th month followup. (a) shows initial, 6-month, and 12-month X-rays and CT scan of the patient. (b) shows initial, 6-month, and 12-month sagittal and axial T1-weighted images. Disease completely healed at 12 months. (c) shows initial, 6-month, and 12-month sagittal and axial T2-weighted images. Disease completely healed at 12 months.
Source publication
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...
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Background
The development of thoracic surgical techniques has provided a new avenue for treating thoracic tuberculosis. Moreover, microscopic treatment of spinal tuberculosis has attracted increasing attention, as it affords good visual access and reduces trauma. Traditional thoracoscopic treatment of spinal tuberculosis usually requires 2–3 passa...
Citations
... Compared with traditional open surgery, VATS offers notable advantages including fewer associated injuries, shorter postoperative recovery time, lower postoperative pain levels, and relatively smaller surgical scars [13,14]. Based on the original VATS technique, the current study used pure uniportal VATS for debridement and bone grafting fusion surgery to treat patients with thoracic tuberculosis, achieving satisfactory therapeutic outcomes. ...
Background
The development of thoracic surgical techniques has provided a new avenue for treating thoracic tuberculosis. Moreover, microscopic treatment of spinal tuberculosis has attracted increasing attention, as it affords good visual access and reduces trauma. Traditional thoracoscopic treatment of spinal tuberculosis usually requires 2–3 passages, accompanied by a corresponding number of incisions. With a large number of conventional thoracoscopic surgeries performed, improved resolution of the microscopic field of view, effective hemostasis of the peripheral vessels using the ultrasonic knife, and many reports in the literature, thoracic tuberculosis can now be treated microscopically by creating a single channel. The aim of this study was to explore the feasibility and surgical technique for thoracic tuberculous spondylitis treatment via debridement and bone graft fusion surgery employing pure uniportal video-assisted thoracic surgery (VATS), combined with posterior internal fixation.
Methods
Seven patients with relatively complete documentation were included in this study. All patients underwent lesion removal and bone graft reconstruction via uniportal VATS with posterior internal fixation. The mean patient age was 39.6 years. Surgical duration, blood loss volume, postoperative recovery time, and thoracic kyphosis angle were recorded.
Results
The surgeries were successful with no severe postoperative complications. All patients were followed-up, and no recurrence of tuberculosis was observed. Imaging data, including computed tomography scans, confirmed the complete removal of the lesions. Additionally, bone fusion at the graft site was successful, no loss of the thoracic kyphosis angle was noted postoperatively, and the thoracic kyphosis angle improved.
Conclusions
Pure uniportal VATS yields satisfactory results and inflicts less trauma than previous surgical techniques. This technique also offers a reference value for treating thoracic tuberculous spondylitis.
... How this is done is another issue altogether and the pendulum is currently swinging away from the large open anterior procedures with anterior strut grafting towards the minimally invasive posterior procedures involving percutaneous pedicle screw and rod placement with mini-posterolateral open debridement and fusion [4]. In those patients where one needs to go anteriorly to reconstruct the anterior and middle columns video-assisted thoracoscopic surgery is moving more and more into the front as the morbidity of a thoracotomy is increasingly being appreciated [8]. ...
Spinal tuberculosis is increasing in prevalence in sub Saharan Africa as we find ourselves at the epicentre of immunosuppression secondary to a human immunodeficiency pandemic. Besides the medical management of this condition spinal surgeons must today still decide on the best way to manage the challenges of myelopathy, instability, deformity, and the pre-vertebral and para-vertebral cold abscesses. The large conventional open procedures for debriding and reconstructing spinal tuberculosis, that include a thoracotomy which utilizes a trans-pleural corridor, the lateral extra cavitary approach which involves rib resection and utilizes the extra-pleural corridor, the posterolateral approach which involves a costotransversectomy and thereafter extra pedicular or transpedicular corridors, are increasingly being recognized to carry with them considerable morbidity. To avoid this minimally invasive procedures are increasingly being utilized in the surgical management of this problem. We present a short series of 4 patients who presented to our unit over a 4-year period with spinal tuberculosis that we managed minimally invasively. Our case report series provides four distinct surgical options, amongst many more that are available, and is as such merely a sample of what can be done. We furthermore conducted a PubMed search on the subject and provide an overview of how minimally invasive spinal surgery is being applied to the problem of spinal tuberculosis around the world.
... The lack of specific imaging features and clinical manifestations makes diagnosis and treatment challenging for clinicians. Surgical resection, including lobectomy or wedge resection, is recommended for all patients to prevent recurrent pulmonary infections and possible malignant transformation (5,(8)(9)(10)(11)(12). ...
Background:
Congenital cystic adenomatoid malformation (CCAM) is a rare congenital malformation of the lungs, however it lacks a summary of pathognomonic clinical and imaging features in adults. Our study aims to evaluate clinical characteristics and surgical treatment in the largest case series of adult CCAM.
Methods:
The records of 46 adult patients with CCAM admitted to West China Hospital between February 2009 and March 2019 were reviewed. All patients accepted the surgery and get fully recovered. Data were collected and analyzed regarding patient demographics, medical history, preoperative investigations, intraoperative findings, and postoperative outcomes.
Results:
The records of 22 men and 24 women were examined. The main systemic and respiratory symptoms included fever, productive cough, hemoptysis, and chest pain. Twenty lesions were found in the right pulmonary lobes and 26 in the left lobes. All CCAM lesions were successfully resected by surgery (35 patients had lobectomies, and the remaining 11 patients underwent wedge resections). Twenty-nine patients underwent video-assisted thoracic surgery (VATS), while 17 patients received posterolateral thoracotomy (PLT). The pathological analysis of surgical specimens revealed 26 cases of pure CCAM lesions and 20 cases of CCAM mixed with other diseases. More than 10% of patients had coexisting pre-malignant or malignant lung lesions. Four patients experienced postoperative complications. No intraoperative and postoperative deaths occurred.
Conclusions:
Surgical resection remains the preferred approach for adults with CCAM and has satisfied outcomes. Clinicians should be aware of possible coexisting infections and malignancies.
... The thoracic and lumbar spine are the most commonly involved sites (90% of cases) [3]. The treatment regimens for thoracic and lumbar TB reported in the English literature include anti-TB chemotherapy (usually combined treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol) [2], traditional surgical treatment (anterior radical debridement with graft fusion or posterior debridement with fusion and fixation) [21][22][23][24][25], and minimally invasive approaches [19,[26][27][28][29][30][31][32]. ...
... Additional surgical intervention is performed if there is evident vertebral instability, failure of chemotherapy, progressive deformity, serious neurological impairment, or presence of extensive PA with or without epidural involvement [22,24,25,[29][30][31][32]. ...
Background:
Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy.
Methods:
A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI).
Results:
The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination.
Conclusion:
MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
... The application of Minimally invasive spinal surgery (MISS) is new in the treatment of spinal tuberculosis and other spinal infections. Several recent studies have however conclusively shown that MISS, applied to the treatment of spinal infections, demonstrated significant advantages over the open approaches namely less soft tissue damage, less intra-operative blood loss, less post-operative pain, reduced scarring, reduced hospital stay and early return to work [1,2]. The incidence of hematogenous vertebral osteomyelitis is increasing parallel to longer life expectancies, chronic disease, better diagnostic techniques, indwelling intravascular catheters and immunosuppressive therapy [3]. ...
The incidence of hematogenous vertebral osteomyelitis is increasing parallel to longer life expectancies, chronic disease, better diagnostic techniques, indwelling intravascular catheters and immunosuppressive therapy. In Sub-Saharan African countries the number of reported spinal tuberculosis cases has tripled secondary to the Acquired immunodeficiency syndrome pandemic. Most patients with spinal infections can be successfully treated non-operatively. Medical management is particularly successful before significant bony destruction has taken place. In patients that require surgical intervention several recent studies have shown that MISS, applied to the treatment of spinal infections, demonstrates significant advantages over the open approaches. In the thoracic spine the exact site of the focus of infection and the extent of kyphosis determines the ideal surgical approach. The following MISS approaches to the thoracic spine are currently utilized 1. Mini-thoracotomy; 2. Mini-open thoracoscopically assisted thoracotomy (MOTA); 3. Video-assisted thoracoscopic surgery (VATS); 4. Video assisted telescopic operating microscope assisted thoracotomy (VITOM thoracotomy); and 5. Percutaneous thoracic fixation. Regarding infections of the lumbar spine neurological complications are uncommon as compared to infection of the thoracic spine. Newer MISS approaches to the lumbar spine utilized in the context of lumbar tuberculosis are the MISS Transforaminal lumbar interbody fusion, MISS Extreme lateral lumbar body interbody fusion and the MISS anterior lumbar interbody fusion. The use of endoscopic spinal decompression in the management of infections of the lumbar spine is a relatively new technique and incurs inherently minimal tissue damage. Minimally invasive anterior approaches to the cervical spine are not commonly performed. MISS-microsurgical anterior approach in the context of cervical spine infection have however been reported. MISS posterior approaches to the cervical spine are also being performed. We aimed to provide a review of the MISS approaches currently in use to treat spinal infections to assist spinal surgeons whom manage this problem.
... Anterior instrumentation is, however, complicated by poor purchase in inflamed osteopenic bone, inability to span multiple segments especially across junctional pathologies, difficulty in extending the instrumentation when necessary, and difficult surgical accessibility in the lumbosacral, occipitocervical, and high thoracic regions 39,40 . Video-assisted thoracoscopic surgery, although reported, has not proved to be superior to posterior-only procedures in terms of surgical time, blood loss, deformity correction, or even neurological recovery 41 . The development of posterior pedicle screw instrumentation allowed posterior-only surgery. ...
Diagnosis of spinal tuberculosis (TB) in the early (inflammatory) stage is essential to prevent the development of spinal deformity and neurological deficit.
➢ As spinal TB is a paucibacillary disease, diagnosis is established through a combination of clinical evaluation, imaging features, acid-fast bacilli smear, mycobacterial culture, histologic and/or cytologic evaluation, and molecular methods of diagnosis. No single modality can ascertain a diagnosis in all cases.
➢ Spinal TB is a medical disease to be treated by antitubercular therapy (ATT) until healing is attained. The consensus for the definition of a healed status in bone and joint TB, and consequent length of ATT intake, remains unresolved. Children with spinal TB need to be followed until skeletal maturity as kyphotic deformity may increase with growth.
➢ The indications for surgery and type of surgery performed (decompression, instrumented stabilization, or deformity correction) are case-specific decisions. Surgical correction of spinal deformity is easier to perform in active disease than in healed disease.
➢ Drug-resistant strains present an emerging challenge. Demonstration of drug resistance is often difficult in patients with spinal TB because of the lack of bacterial growth on culture. Molecular methods of diagnosis are often useful in such patients. Establishment of treatment protocols requires further long-term and large-scale clinical trials.
... It has been developed from simple anterior discectomy and debridement to anterior spinal instrumentation and reconstruction, and has applications in a wide range of fields. A large number of literatures have confirmed its minimal invasion, safety and efficacy [11][12][13]. However, due to the higher requirements of surgical techniques, the need for more departments, longer learning curve, expensive equipment and other factors, there are also limitations of clinical application. ...
Background:
To investigate the clinical efficacy of minimally invasive direct lateral approach debridement, interbody bone grafting, and interbody fusion in the treatment of the thoracic and lumbar spinal tuberculosis.
Methods:
From January 2013 to January 2016, 35 cases with thoracic and lumbar spinal tuberculosis received direct lateral approach debridement, interbody bone grafting, and interbody fusion. Of the 35 cases, 16 patients were male and 19 were female and the median age was 55.2 (range 25-83). The affected segments were single interspace, and the involved vertebral bodies included: 15 cases of thoracic vertebrae (1 cases of T5/6, 2 cases of T6/7, 4 cases of T7/8, 3 cases of T8/9, 5 cases of T9/10) and 20 cases of lumbar spine (2 cases of L1/2, 6 cases of L2/3, 6 cases of L3/4, 6 cases of L4/5). After MIDLIF operation, all the patients received medication of four anti-tubercular drugs for 12 to18 months.
Results:
The patients were followed up for 7 to 40 months with an average of 18.5 months. The visual analogue scale (VAS) at the last follow-up was 2.8 ± 0.5, which was significantly different from the preoperative VAS (8.2 ± 0.7). After MIDLIF, there was 5 cases occurred with transient numbness in one side of the thigh or inguinal region, and 10 cases suffered from flexion hip weakness. All the bone grafts were fused within 6~ 18 months (average of 11.5 months) after the operation.
Conclusion:
Minimally invasive lateral approach interbody fusion technology have the advantage of less injury and quick recovery after surgery, which is the effective and safe treatment for thoracic and lumbar spinal tuberculosis.
... Guerado et al. 9 reported that although open decompression of spondylodiscitis is still the standard procedure, minimally invasive techniques like VATS have good results when used early in the disease course. Similarly, Singh et al. 10 in their series of patients treated with VATS for tubercular spondylitis reported good outcomes, with decreased blood loss and postoperative morbidity. The VATS is a safer and less cumbersome alternative to open thoracotomy, both to the patient and the surgeon. ...
Tuberculosis of the spine is the second most common extrapulmonary presentation of the disease and is associated with significant morbidity. The drainage of the abscess may be needed in patients who fail to respond to medical treatment and present with a significant or deteriorating neurologic status. The dorsal spine gives a unique opportunity for decompression alone as it is supported by the rib cage, decreasing the chances of collapse. Drainage of the abscess in the dorsal spine usually needs an open thoracotomy. Open thoracotomy is associated with increased blood loss, pain, and increased postoperative rehabilitation period. Video-assisted thoracoscopic surgery (VATS) is an excellent alternative for decompression of dorsal paraspinal abscess with significantly decreased blood loss, soft tissue dissection, scarring, and hospital stay. Overall, this leads to significantly decreased postoperative morbidity and faster recovery. The purpose of this article was to describe the indications and procedure of VATS for drainage of dorsal spine paravertebral abscess.
... Recent advancements of technologies in neurosurgical equipments and techniques have changed the outcome of some of previously surgically untreatable spinal conditions [24][25][26][27][28][29][30][31][32]. Video-assisted thoracoscopic surgeries, anterior and anterolateral transthorasic, retroperiotoneal and posterior approaches along with newer prosthetic implants have left no dorsal spinal condition untreatable surgically [16,17,19,28,32,33]. ...
... Recent advancements of technologies in neurosurgical equipments and techniques have changed the outcome of some of previously surgically untreatable spinal conditions [24][25][26][27][28][29][30][31][32]. Video-assisted thoracoscopic surgeries, anterior and anterolateral transthorasic, retroperiotoneal and posterior approaches along with newer prosthetic implants have left no dorsal spinal condition untreatable surgically [16,17,19,28,32,33]. However there is another extreme of the spectrum in developing countries where many poor patients are left untreated due to lack of adequate infrastructure (number of beds/hospitals), human resource (medical and paramedical staff), literacy/awareness and capacity to afford cost of implants at public healthcare facility or cost of treatment at private healthcare facility [2, 3, 14, [34][35][36][37][38][39][40][41][42]. ...
Abstract
Introduction: Spinal tuberculosis is prevalent in developing countries. Advancements in technique and technology has improved the outcome, but cost of the newer prosthetic implants and insufficient public healthcare infrastructure in third world countries pose difficulty in surgical treatment of many of these
patients.
Methods: Twenty two patients of dorsal Pott’s disease having anterior or anterolateral compressions with significant neurological deficits were prospectively studied in five years period (2010 to 2015) and were subjected to unilateral transpedicular decompression of the dorsal cord with maximal preservation of
bony elements including ribs without fixation by prosthetic implants. Patients were advised absolute bed rest for 3 months after surgery.
Results: Study group included 12 males and 10 females of with average age 37.5 years (range 14 to 68 years). Clinical improvement was observed in all but one patient, who showed recovery in the follow up. Three patients had recurrence with neurological deterioration due to discontinued antitubercular chemotherapy and required second surgery leading to clinical recovery. There was no increase in kyphosis in follow up in any patient.
Conclusion: Unilateral transpedicular decompression with bed rest for three months appear an option in selected patients of dorsal Pott’s disease with anterior/ anterio-lateral compression with significant neurological deficit.
... Recent advancements of technologies in neurosurgical equipments and techniques have changed the outcome of some of previously surgically untreatable spinal conditions [24][25][26][27][28][29][30][31][32]. Video-assisted thoracoscopic surgeries, anterior and anterolateral transthorasic, retroperiotoneal and posterior approaches along with newer prosthetic implants have left no dorsal spinal condition untreatable surgically [16,17,19,28,32,33]. ...
... Recent advancements of technologies in neurosurgical equipments and techniques have changed the outcome of some of previously surgically untreatable spinal conditions [24][25][26][27][28][29][30][31][32]. Video-assisted thoracoscopic surgeries, anterior and anterolateral transthorasic, retroperiotoneal and posterior approaches along with newer prosthetic implants have left no dorsal spinal condition untreatable surgically [16,17,19,28,32,33]. However there is another extreme of the spectrum in developing countries where many poor patients are left untreated due to lack of adequate infrastructure (number of beds/hospitals), human resource (medical and paramedical staff), literacy/awareness and capacity to afford cost of implants at public healthcare facility or cost of treatment at private healthcare facility [2,3,14,[34][35][36][37][38][39][40][41][42]. ...
Introduction: Spinal tuberculosis is prevalent in developing countries. Advancements in technique and technology has improved the outcome, but cost of the newer prosthetic implants and insufficient public healthcare infrastructure in third world countries pose difficulty in surgical treatment of many of these patients.
Methods: Twenty two patients of dorsal Pott’s disease having anterior or anterolateral compressionswith significantneurologicaldeficitswereprospectively studied in five years period (2010 to 2015) and were subjected to unilateral transpedicular decompression of the dorsal cord with maximal preservation of bony elements including ribs without fixation by prosthetic implants. Patients were advised absolute bed rest for 3 months after surgery.
Results: Study group included 12 males and 10 females of with average age 37.5 years (range 14 to 68 years). Clinical improvement was observed in all but one patient, who showed recovery in the follow up. Three patients had recurrence with neurological deterioration due to discontinued antitubercular chemotherapy and required second surgery leading to clinical recovery. There was no increase in kyphosis in follow up in any patient.
Conclusion: Unilateral transpedicular decompression with bed rest for three months appear an option in selected patients of dorsal Pott’s disease with anterior/ anterio-lateral compression with significant neurological deficit.
