Simultaneous Video- Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar Infections

Abstract

Background Data: with increased life expectancy, the incidence of spinal infections in elderly with debilitating disease is rising. The traditional operative therapy in this age group has several morbidities and increased mortality rate. The usage of minimally invasive surgeries in these patients give promising results to overcome or reduces those morbidities and to avoid devastating surgical complications. Study Design: A prospective observational study. Purpose: was to determine whether the combination of video- assisted thoracoscopic debridement and reconstruction with posterior percutaneous transpedicular instrumentation in prone position achieves treatment goals in thoracic and thoracolumbar spinal infections and minimizes the associated morbidities. Patients and Methods: Between May 2010 and May 2013, 61 consecutive patients with spinal infections at the thoracic and thoracolumbar junction were operated upon in our hospital. Those patients underwent anterior thoracoscopically assisted debridement and fusion plus posterior percutaneous stabilization in prone position. The clinical and radiological assessments of these patients were evaluated preoperatively and postoperatively with mean follow up of 37.7 months. The clinical outcomes data were assessed postoperatively and final follow-up by use of VAS and subjective clinical results. Plain X-ray in two views was used for the radiological outcome evaluation. Results: Sixty one patients were included (38 males and 23 females) with mean age of 67.5 years, 78% were older than 60 years. More than 80% of the patients had associated comorbidities. The mean operative timewas 195.49 ± 41.60 minutes, for thoracoscopic anterior surgery was 100.57 ±29.14, and for posterior surgery was 94.92 ± 28.35 minutes. The average blood loss was 597.54 ml. Thirty two patients (52%) had preoperative neurological deficits ranging from Frankel A to D. One patient (Frankel A) did not show any neurological improvement at the final follow-up. The mean VAS at final follow-up was 1.03/10 (preoperative 7.89). The mean preoperative kyphosis angle was 17.11°, improved to 6.51°postoperatively and reached 8.48° at the final follow-up. First year mortality rate was 6.5% (4 patients). Conclusion: Minimal invasive spinal techniques including thoracoscopic debridement and fusion and posteriorpercutaneous instrumentation showed good clinical and radiological outcomes and can be considered as alternative to open procedures with decreased rates of morbidities in managing thoracic and thoracolumbar infections in elderly patients. (2014ESJ074)

Keywords

• Spinal infections
• surgical treatment
• VATS
• thoracoscopic
• percutaneous instrumentation