Figures Figures22 and and33 are the photographs of X-rays, CT and kinase inhibitor Trichostatin A MRI of the representative cases at presentation, six months, and 12 months. Figure 2 Tubercular spondylitis thoracic spine (D10-D11). Patient had a good subjective outcome and all changes in laboratory and radiological (MRI, CT, and X-rays) parameters showed improvement by the end of 12 months. Fusion was achieved at 12 months. No complications … Figure 3 Tubercular spondylitisthoracic (D9-D10) with neurologic deficit. VATS along with minithoracotomy and placement of bone graft was done. Conversion to minithoracotomy was done because of dense pleural adhesions and difficulty in making portals was also … 4.

Discussion Evidence of tuberculous spondylitis, probably due to infection with mycobacterium bovis, was identified in mummies from the tomb of nebeveenenf, indicating that this process existed in dynastic Egypt as early as 3700BC [19]. Skeletal tuberculosis still remains a major health concern as it accounts for at least 10% of cases of extrapulmonary infection, and spine is the most common site of bony involvement [10]. Absolute indications for surgery in patients with spinal tuberculosis under active treatment are approximately 6% in those without neurologic deficit and approximately 60% in those with neurologic deficit [20]. The standard surgical method of decompression of tubercular dorsal spine is either the anterolateral extrapleural or open transthoracic transpleural approach. Both these approaches are sufficient for adequate decompression and graft placement but are associated with significant morbidity and require a prolonged hospital stay [15].

Video-assisted thoracoscopic surgery (VATS) is a good surgical alternative to conventional thoracotomy with minimal morbidity [21], though surgically demanding. VATS has been used extensively in spinal deformities such as scoliosis with results comparable to open procedures, but there has been limited use of VATS for decompression in active tuberculosis of dorsal spine [16]. It is recommended to do bone grafting in tuberculous spine when significant bone loss has occurred. Once the adjacent vertebral bodies develop destructive lesions, vertebral collapse may follow, due to destruction of cancellous bone, producing anterior or lateral wedging. Bone graft provides the stability and prevents further collapse of spine [12].

In our study, bone grafting was done in three patients. The operative time in our series ranged from 105 to 165 minutes, this variation was due to the different types of procedures performed, and, as expected, the operative time for each Dacomitinib procedure was longer initially and decreased with experience. Our mean operative time was less as compared to other studies (Table 3) because we did not go for spinal instrumentation and bone grafting was done only in three patients in this short series.