Video-assisted thoracoscopic anterior surgery combined posterior instrumentation for children with spinal tuberculosis.

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.