Abstract
Background The use of thoracoscopy for the treatment of spinal disorders has been applied mostly
in adults. However, thoracoscopic decompression of spinal tuberculosis in children
has probably been rarely documented.
Objective To assess the efficacy of video-assisted thoracoscopic anterior surgery (VATS) combined
with posterior instrumentation for children with spinal tuberculosis.
Study Design Total 15 consecutive children with spinal tuberculosis with VATS combined with posterior
instrumentation were included.
Methods Overall 15 cases of spinal tuberculosis were treated with the procedure of posterior
internal fixation and anterior debridement by VATS combined with posterior instrumentation
between January 2002 and December 2006.There were nine males and six females with
an average age of 11.6 years (8–15 y). All patients were given appropriate chemotherapy
for 4 to 12 weeks preoperatively and 12 to 15 months postoperatively. All patients
were followed up with evaluation of the changes of kyphotic deformity noted.
Results All the cases were followed up over an average of 37.3 months (range, 12–48 mo).The
wounds were healed without chronic infection or sinus formation. Four patients improved
three grades, two patients improved two grades, and seven patients improved one grade.
The average neurological recovery in the patients was 1.44 grades on the scale by
Frankel et al. The average preoperative kyphosis was 37 degrees (range, 23–59 degrees)
and the average postoperative kyphosis was 25 degrees (range, 18–35 degrees) at final
follow-up. Also, minimal progression of kyphosis was seen at final follow-up with
an average kyphosis of 28 degrees (range, 20–40 degrees); and average loss of correction
of 3 degree was seen at final follow-up.
Conclusions VATS combined with posterior instrumentation achieve satisfactory results for children
with spinal tuberculosis.
Keywords
tuberculosis - thoracic spine - video-assisted thoracoscopic surgery - children
