Simultaneous Video-Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar Infections
Authors: Abdelrahman Hamdan , Hasan Mohamed Gamal , El-Meshtawy Mohamed , Younis Khalid , Shousha Mootaz , Boehm Heinrich 
Published: April 2016

Introduction

The incidence of vertebral osteomyelitis is reported to range between 2–7% of all cases of bone infection. Spinal infection is age-related and has been on the rise over the last decades. Thus, it occurs frequently in elderly and debilitated patients who have significant medical comorbidities and predisposing factors for spinal infection. The thoracic spine and thoracolumbar junction are areas frequently involved in various types of spinal infections. The aim of surgery in spinal osteomyelitis is to relieve pain by eradication of the infection, reconstruction of the defects and restabilization of the spine. Anterior radical debridement and spinal fusion is advocated as an effective treatment of these infections. Video assisted thoracoscopic surgery (VATS), in cases of thoracic and thoracolumbar spinal infection, is a good alternative to conventional thoracotomy with minimal morbidity, although surgically demanding. There are few reports in the literature of VATS performed on prone patients. This study analyses prospectively 61 patients, who were operated upon for thoracic or thoracolumbar spinal infection in a single tertiary-care referral hospital, between May 2010 and May 2013 using VATS combined with percutaneous fixation in all patients while the patient positioned prone.

Material and Methods

Between May 2010 and May 2013, 61 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 consecutive 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 time was 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 597.54ml. 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 posterior percutaneous 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.