Simultaneous Video- Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar Infections

Background Data: with increased life expectancy, the incidence of spinal infections in elderly with debilitating disease is rising. The traditional operative therapy in this age group has several morbidities and increased mortality rate. The usage of minimally invasive surgeries in these patients gi...

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Autores principales:	Hamdan Abdelrahman, Mohamed Hassan, Mohamed El-meshtawy, Khalid Hassan, Mootaz Shousha, Heinrich Boehm
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2015
Materias:	Spinal infections surgical treatment VATS thoracoscopic percutaneous instrumentation Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/3301603ea009472596349636e313869d
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spelling	oai:doaj.org-article:3301603ea009472596349636e313869d2021-12-02T07:22:32ZSimultaneous Video- Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar InfectionsDOI:10.21608/ESJ.2015.39712314-89502314-8969https://doaj.org/article/3301603ea009472596349636e313869d2015-07-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_3971.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: with increased life expectancy, the incidence of spinal infections in elderly with debilitating disease is rising. The traditional operative therapy in this age group has several morbidities and increased mortality rate. The usage of minimally invasive surgeries in these patients give promising results to overcome or reduces those morbidities and to avoid devastating surgical complications. Study Design: A prospective observational study. Purpose: was to determine whether the combination of video- assisted thoracoscopic debridement and reconstruction with posterior percutaneous transpedicular instrumentation in prone position achieves treatment goals in thoracic and thoracolumbar spinal infections and minimizes the associated morbidities. Patients and Methods: Between May 2010 and May 2013, 61 consecutive patients with spinal infections at the thoracic and thoracolumbar junction were operated upon in our hospital. Those patients underwent anterior thoracoscopically assisted debridement and fusion plus posterior percutaneous stabilization in prone position. The clinical and radiological assessments of these patients were evaluated preoperatively and postoperatively with mean follow up of 37.7 months. The clinical outcomes data were assessed postoperatively and final follow-up by use of VAS and subjective clinical results. Plain X-ray in two views was used for the radiological outcome evaluation. Results: Sixty one patients were included (38 males and 23 females) with mean age of 67.5 years, 78% were older than 60 years. More than 80% of the patients had associated comorbidities. The mean operative timewas 195.49 ± 41.60 minutes, for thoracoscopic anterior surgery was 100.57 ±29.14, and for posterior surgery was 94.92 ± 28.35 minutes. The average blood loss was 597.54 ml. Thirty two patients (52%) had preoperative neurological deficits ranging from Frankel A to D. One patient (Frankel A) did not show any neurological improvement at the final follow-up. The mean VAS at final follow-up was 1.03/10 (preoperative 7.89). The mean preoperative kyphosis angle was 17.11°, improved to 6.51°postoperatively and reached 8.48° at the final follow-up. First year mortality rate was 6.5% (4 patients). Conclusion: Minimal invasive spinal techniques including thoracoscopic debridement and fusion and posteriorpercutaneous instrumentation showed good clinical and radiological outcomes and can be considered as alternative to open procedures with decreased rates of morbidities in managing thoracic and thoracolumbar infections in elderly patients. (2014ESJ074)Hamdan Abdelrahman Mohamed Hassan Mohamed El-meshtawyKhalid Hassan Mootaz Shousha Heinrich BoehmEgyptian Spine AssociationarticleSpinal infectionssurgical treatmentVATSthoracoscopicpercutaneous instrumentationNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 15, Iss 1, Pp 15-23 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	Spinal infections surgical treatment VATS thoracoscopic percutaneous instrumentation Neurology. Diseases of the nervous system RC346-429
spellingShingle	Spinal infections surgical treatment VATS thoracoscopic percutaneous instrumentation Neurology. Diseases of the nervous system RC346-429 Hamdan Abdelrahman Mohamed Hassan Mohamed El-meshtawy Khalid Hassan Mootaz Shousha Heinrich Boehm Simultaneous Video- Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar Infections
description	Background Data: with increased life expectancy, the incidence of spinal infections in elderly with debilitating disease is rising. The traditional operative therapy in this age group has several morbidities and increased mortality rate. The usage of minimally invasive surgeries in these patients give promising results to overcome or reduces those morbidities and to avoid devastating surgical complications. Study Design: A prospective observational study. Purpose: was to determine whether the combination of video- assisted thoracoscopic debridement and reconstruction with posterior percutaneous transpedicular instrumentation in prone position achieves treatment goals in thoracic and thoracolumbar spinal infections and minimizes the associated morbidities. Patients and Methods: Between May 2010 and May 2013, 61 consecutive patients with spinal infections at the thoracic and thoracolumbar junction were operated upon in our hospital. Those patients underwent anterior thoracoscopically assisted debridement and fusion plus posterior percutaneous stabilization in prone position. The clinical and radiological assessments of these patients were evaluated preoperatively and postoperatively with mean follow up of 37.7 months. The clinical outcomes data were assessed postoperatively and final follow-up by use of VAS and subjective clinical results. Plain X-ray in two views was used for the radiological outcome evaluation. Results: Sixty one patients were included (38 males and 23 females) with mean age of 67.5 years, 78% were older than 60 years. More than 80% of the patients had associated comorbidities. The mean operative timewas 195.49 ± 41.60 minutes, for thoracoscopic anterior surgery was 100.57 ±29.14, and for posterior surgery was 94.92 ± 28.35 minutes. The average blood loss was 597.54 ml. Thirty two patients (52%) had preoperative neurological deficits ranging from Frankel A to D. One patient (Frankel A) did not show any neurological improvement at the final follow-up. The mean VAS at final follow-up was 1.03/10 (preoperative 7.89). The mean preoperative kyphosis angle was 17.11°, improved to 6.51°postoperatively and reached 8.48° at the final follow-up. First year mortality rate was 6.5% (4 patients). Conclusion: Minimal invasive spinal techniques including thoracoscopic debridement and fusion and posteriorpercutaneous instrumentation showed good clinical and radiological outcomes and can be considered as alternative to open procedures with decreased rates of morbidities in managing thoracic and thoracolumbar infections in elderly patients. (2014ESJ074)
format	article
author	Hamdan Abdelrahman Mohamed Hassan Mohamed El-meshtawy Khalid Hassan Mootaz Shousha Heinrich Boehm
author_facet	Hamdan Abdelrahman Mohamed Hassan Mohamed El-meshtawy Khalid Hassan Mootaz Shousha Heinrich Boehm
author_sort	Hamdan Abdelrahman
title	Simultaneous Video- Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar Infections
title_short	Simultaneous Video- Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar Infections
title_full	Simultaneous Video- Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar Infections
title_fullStr	Simultaneous Video- Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar Infections
title_full_unstemmed	Simultaneous Video- Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar Infections
title_sort	simultaneous video- assisted thoracoscopic debridement/ fusion and percutaneous transpedicular instrumentation in prone position for thoracic and thoracolumbar infections
publisher	Egyptian Spine Association
publishDate	2015
url	https://doaj.org/article/3301603ea009472596349636e313869d
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Simultaneous Video- Assisted Thoracoscopic Debridement/ Fusion and Percutaneous Transpedicular Instrumentation in Prone Position for Thoracic and Thoracolumbar Infections

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