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 procedureis the lateral decubitus. This make the surgeon oriented to the field since this thesame position of the traditional thoracotomy and make it easy for conversionto open surgery if needed. Prone position; although may be difficult; has theadvantage of performing two major procedures; posterior fusion and anteriorreconstruction by at same time with minimized morbidity and mortality.Purpose: To evaluate the efficacy and safety of VATS in management of differentdorolumbar spine pathologies.Study Designs: Prospective clinical case study.Patients and Methods: Eighty six cases of kyphotic deformities due to variouspathologies (28 cases of fractures, 42 infection, 16 tumors) were treated bysimultaneous posterior fusion techniques and anterior reconstruction by VATSusing bone grafts, cages and spacers while the patient is in prone position. Themean follow up of the patients was 26.1 months. All patients were evaluatedradiographically preoperatively, postoperatively and at the end of follow upusing Cobb angle. Radiographs at the final follow up were assessed for fusion.VAS was used to evaluate pain of the thoracoscopic mini incision. All caseswere assessed neurologically by Frankel grading system and Denis pain scorefor back pain at the end of follow up. Operative time, intra and postoperativecomplications and blood loss were reported.Results: The mean age was 40.3 years. The regional Cobb angle improved from34.7° preoperatively to 11.6° postoperatively. Most of patients had improvedon both Frankel grading system and scores of pain. There was no indication toconvert any case to open procedure. No serious intraoperative complicationoccurred but one case of massive bleeding due to injury of one intercostal vesselthat has been controlled thoracoscopically. The postoperative complicationsincluded chest infection, delayed lung inflation, intercostals neuralgia andtransient neurological deficits.Conclusion: VATS using limited mini-incison provide an excellent and safeapproach for management of dorsolumbar pathologies. Prone position facilitateshandling of the spine both anteriorly and posteriorly at the same time to get themaximum benefit offered by both approaches without excessive morbidity tothe patient. (2012ESJ020)