Clinical Comparison Of Anterior Surgery Assisted By Thoracoscopy-assisted Mini-open Surgery And Open Approach For Thoracic Spinal Tuberculosis

Objective To evaluate the clinical effects of thoracoscopy-assisted mini-open and open procedures for anterior surgery of thoracic spine tuberculosis.Methods 110 patients with thoracic spine tuberculosis were retrospectively analyzed between May 1998 and May 2005 . Group A (underwent thoracoscopy- assisted mini-open): There were 35males and 23 females with a mean of age of 39.2±4.1 years old . The involved segments were from T₄ to T₁₂ , 38 cases occurred neurological dysfunction, the average kyphotic angle was 29.2±4.5°with a range from 18°to 42°in preoperation . Group B(underwent open procedures): There were 28 males and 24 females with an average age of 37.6±4.5years old . The involved segments were from T₄ to T₁₂, there were 33 cases complicated with neurological dysfunction, the average kyphotic angle was 30.3±1.5°with a range of from 19°to 45°in pre-operation . All the patients were followed up for 2 yeas. Dorsalgia is evaluated pre-operation and postoperation. SUK is used for evaluate if there is fusion between vertebra and bone graft by X-rays. Frankel is used for evaluate the neurological function. Use SPSS13.0 to compare operation time, blood loss in the operation, chest tube drainage, duration of chest tube drainage, duration of chest pain, complications, neurological function, kyphotic angle, pulmonary function, backache.Results The average blood loss,mean drainage volume,hospital stays and duration of chest pain in group A were less than group B , P<0.05 ; The average operative time , tube removed time and clinical outcomes had no difference between A and B, P>0. 05;The kyphotic angle correction of preoperative,1 week after operation and 2-year follow up had no difference between A and B, P>0.05; It was different of the correction of kyphotic angle intergroup analysis , P <0.01;Neurological improved in all patients . It was different of the complications : Group A, complications occurred in 18 patients(31%), P<0.05; Group B, complications occurred in 27 patients(51.9%). The follow-up time was 2 years of all the patients, neurological improvement had 71 cases , no hardware failure and obvious loss of correction and no recurrence, furthermore, all the spinal fusion was well. The appearance of the incision is more comfortable in group A. And it is also have less hospital stays. Backache had no difference between A and B, P>0. 05.Conclusion Thoracoscopy- assisted mini-open surgery for thoracic spinal tuberculosis is proved to have the same outcomes as traditional open surgery, it can decrease incision size, blood loss, mean drainage volume, duration of chest pain and hospital stays, especially reduce complication and upper extremity dysfunction. This approach is secure and available in clinical application.