Simultaneous Posterior Fusion with Video Assisted Thoracoscopic Surgery (VATS) for Treatment of Kyphotic Deformities in Prone Position. A Series of 86 Cases

Abstract

Background Data: The traditional position of the patient during VATS procedure is the lateral decubitus. This make the surgeon oriented to the field since this the same position of the traditional thoracotomy and make it easy for conversion to open surgery if needed. Prone position; although may be difficult; has the advantage of performing two major procedures; posterior fusion and anterior reconstruction by at same time with minimized morbidity and mortality. Purpose: To evaluate the efficacy and safety of VATS in management of different dorolumbar spine pathologies. Study Designs: Prospective clinical case study. Patients and Methods: Eighty six cases of kyphotic deformities due to various pathologies (28 cases of fractures, 42 infection, 16 tumors) were treated by simultaneous posterior fusion techniques and anterior reconstruction by VATS using bone grafts, cages and spacers while the patient is in prone position. The mean follow up of the patients was 26.1 months. All patients were evaluated radiographically preoperatively, postoperatively and at the end of follow up using Cobb angle. Radiographs at the final follow up were assessed for fusion. VAS was used to evaluate pain of the thoracoscopic mini incision. All cases were assessed neurologically by Frankel grading system and Denis pain score for back pain at the end of follow up. Operative time, intra and postoperative complications and blood loss were reported. Results: The mean age was 40.3 years. The regional Cobb angle improved from 34.7° preoperatively to 11.6° postoperatively. Most of patients had improved on both Frankel grading system and scores of pain. There was no indication to convert any case to open procedure. No serious intraoperative complication occurred but one case of massive bleeding due to injury of one intercostal vessel that has been controlled thoracoscopically. The postoperative complications included chest infection, delayed lung inflation, intercostals neuralgia and transient neurological deficits. Conclusion: VATS using limited mini-incison provide an excellent and safe approach for management of dorsolumbar pathologies. Prone position facilitates handling of the spine both anteriorly and posteriorly at the same time to get the maximum benefit offered by both approaches without excessive morbidity to the patient. (2012ESJ020)

Keywords

• video assisted thoracoscopic surgery
• dorsal kyphosis
• dorsolumbar spine
• prone position