It was then correlated with plain radiography and magnetic resonance imaging (MRI). Inclusion criteria were doubtful diagnosis, severe back pain and/or radicular pain persisting after conservative selleck treatment, neurological deficit resulting from the presence of granulation tissue, abscess or sequestrated bone or a disc fragment compressing the dura, or a paravertebral abscess under tension. Exclusion criteria were multilevel disease, concomitant cervical or lumbar lesion, pleural adhesions, and intolerance to one-lung ventilation intraoperatively. Patients were given detailed information regarding surgical procedure. Prior written informed consent was taken from each patient explaining the procedure, risks, and benefits.

They were also informed that VATS can be converted into open thoracotomy in conditions like inability to tolerate one-lung ventilation or severe pleural adhesions. The surgery was performed under general anesthesia with a double-lumen endotracheal tube inserted for ipsilateral lung collapse and single lung ventilation. A close watch on all hemodynamic and respiratory parameters was maintained. The patients were placed in the right/left lateral decubitus position, depending on the radiologic findings (i.e., bulk of abscess and caseating tissue and destruction of body) and the relevant part was draped and prepared for a standard posterolateral thoracotomy (for conversion to standard thoracotomy in circumstance of intraoperative complication or the presence of severe pleural adhesion).

With selective collapse of right/left lung, the initial trocar incision (2cm) was made usually at the fifth or sixth intercostal space (ICS) or higher along the anterior axillary line depending upon the site of lesion. An 11-mm trocar was used to introduce the operating thoracoscope and an exploratory thoracoscopy was performed. The lesion site was identified and displayed on the video monitor. Two other stab incisions, the extended manipulating channels, usually 3-4cm in length, were done 2-3 intercostal spaces above and below the first port, slightly posterior to the posterior axillary line. We encountered difficulty in making portals due to overcrowding of ribs in two patients. Visualization of the spine was enhanced by tilting the patient forward so that the collapsed lung fell anteriorly and, if required, a fan retractor for further retraction of ipsilateral lung was inserted.

The correct level of diseased vertebrae Cilengitide was determined by counting the ribs as seen through the endoscope. Putting a spinal needle from the marker site and visualizing the tip of needle through the thoracoscope further confirmed the correct level. With monopolar electrocautery accompanied by a suction tube the parietal pleura overlying the lesion was divided longitudinally. The larger intercostal arteries and veins were isolated, ligated, and divided if needed.