J Korean Neurosurg Soc.  2007 Oct;42(4):293-299. 10.3340/jkns.2007.42.4.293.

Clinical Analysis of Video-assisted Thoracoscopic Spinal Surgery in the Thoracic or Thoracolumbar Spinal Pathologies

• Kim SJ
• Sohn MJ
• Ryoo JY
• Kim YS
• Whang CJ

• KMID: 2189264
• DOI: http://doi.org/10.3340/jkns.2007.42.4.293

Abstract

OBJECTIVE
Thoracoscopic spinal surgery provides minimally invasive approaches for effective vertebral decompression and reconstruction of the thoracic and thoracolumbar spine, while surgery related morbidity can be significantly lowered. This study analyzes clinical results of thoracoscopic spinal surgery performed at our institute.
METHODS
Twenty consecutive patients underwent video-assisted thoracosopic surgery (VATS) to treat various thoracic and thoracolumbar pathologies from April 2000 to July 2006. The lesions consisted of spinal trauma (13 cases), thoracic disc herniation (4 cases), tuberculous spondylitis (1 case), post-operative thoracolumbar kyphosis (1 case) and thoracic tumor (1 case). The level of operation included upper thoracic lesions (3 cases), midthoracic lesions (6 cases) and thoracolumbar lesions (11 cases). We classified the procedure into three groups: stand-alone thoracoscopic discectomy (3 cases), thoracoscopic fusion (11 cases) and video assisted mini-thoracotomy (6 cases).
RESULTS
Analysis on the Frankel performance scale in spinal trauma patients (13 cases), showed a total of 7 patients who had neurological impairment preoperatively : Grade D (2 cases), Grade C (2 cases), Grade B (1 case), and Grade A (2 cases). Four patients were neurologically improved postoperatively, two patients were improved from C to E, one improved from grade D to E and one improved from grade B to grade D. The preoperative Cobb's and kyphotic angle were measured in spinal trauma patients and were 18.9+/-4.4 degrees and 18.8+/-4.6 degrees, respectively. Postoperatively, the angles showed statistically significant improvement, 15.1+/-3.7 degrees and 11.3+/-2.4 degrees, respectively (P<0.001).
CONCLUSION
Although VATS requires a steep learning curve, it is an effective and minimally invasive procedure which provides biomechanical stability in terms of anterior column decompression and reconstruction for anterior load bearing, and preservation of intercostal muscles and diaphragm.

Keyword

Video-assisted thoracoscopic surgery; Minimally invasive surgical procedure; Spinal fractures; Spinal fusion

MeSH Terms

Decompression
Diaphragm
Diskectomy
Humans
Intercostal Muscles
Kyphosis
Learning Curve
Pathology*
Spinal Fractures
Spinal Fusion
Spine
Spondylitis
Thoracic Surgery, Video-Assisted
Weight-Bearing