Video-assisted thoracoscopic anterior surgery for tuberculous spondylitis

In the absence of major deformity, the major goal of surgery in tuberculous spondylitis is to achieve adequate cord decompression and débridement of diseased tissue. We asked whether video-assisted thoracoscopic surgery (VATS) could be undertaken in active tuberculosis of the spine with instrumentation and achieve good healing of the disease with fusion and with adequate decompression of the cord to achieve neural recovery. We retrospectively reviewed 23 patients (13 men and 10 women with an average age of 38.2 years) with single-level thoracic spinal tuberculosis (T4-T11) treated with VATS. Of the 23 patients, 18 had paraparesis/paraplegia. The procedures included: (1) débridement and drainage of prevertebral and paravertebral abscess (n = 4); (2) débridement, decompression, and reconstruction with rib graft (n = 8); (3) débridement, decompression, anterior vertical titanium mesh cage, and open posterior screw-rod fixation (n = 5); and (4) débridement, decompression, and anterior screw-rod fixation (n = 6). Twenty-two of 23 patients achieved fusion and there was no recurrence of the disease in any of the patients. No patient had neurological deterioration and 17 of the 18 neurologically compromised patients regained ambulatory power. Small scars (for surgical portals), early mobilization, and short hospital stays were the salient advantages.