Background Data: The traditional position of the patient during VATS procedure
is the lateral decubitus. This make the surgeon oriented to the field since this the
same position of the traditional thoracotomy and make it easy for conversion
to open surgery if needed. Prone position; although may be difficult; has the
advantage of performing two major procedures; posterior fusion and anterior
reconstruction by at same time with minimized morbidity and mortality.
Purpose: To evaluate the efficacy and safety of VATS in management of different
dorolumbar spine pathologies.
Study Designs: Prospective clinical case study.
Patients and Methods: Eighty six cases of kyphotic deformities due to various
pathologies (28 cases of fractures, 42 infection, 16 tumors) were treated by
simultaneous posterior fusion techniques and anterior reconstruction by VATS
using bone grafts, cages and spacers while the patient is in prone position. The
mean follow up of the patients was 26.1 months. All patients were evaluated
radiographically preoperatively, postoperatively and at the end of follow up
using Cobb angle. Radiographs at the final follow up were assessed for fusion.
VAS was used to evaluate pain of the thoracoscopic mini incision. All cases
were assessed neurologically by Frankel grading system and Denis pain score
for back pain at the end of follow up. Operative time, intra and postoperative
complications and blood loss were reported.
Results: The mean age was 40.3 years. The regional Cobb angle improved from
34.7° preoperatively to 11.6° postoperatively. Most of patients had improved
on both Frankel grading system and scores of pain. There was no indication to
convert any case to open procedure. No serious intraoperative complication
occurred but one case of massive bleeding due to injury of one intercostal vessel
that has been controlled thoracoscopically. The postoperative complications
included chest infection, delayed lung inflation, intercostals neuralgia and
transient neurological deficits.
Conclusion: VATS using limited mini-incison provide an excellent and safe
approach for management of dorsolumbar pathologies. Prone position facilitates
handling of the spine both anteriorly and posteriorly at the same time to get the
maximum benefit offered by both approaches without excessive morbidity to
the patient. (2012ESJ020)