Breathe Easy

Thoracoscopic Decortication in Curing Pott’s
Spine Disease

THE CASE

A patient with a history of empyema with hydrothorax of the left lung for which he was diagnosed as TB infected was admitted to Nanavati Super Speciality Hospital. He was taking anti-tubercular drugs but was plagued with intermittent fever and breathlessness for which ICD had been inserted two months back at another hospital. MRI studies revealed L3- L4 Spondylodiskitis and concentric bulge with posterocentral protrusion of L4-L5 disc, ligamentum flavum thickening and facetal arthropathy and paravertebral collections. All these conditions suggested that the patient was suffering from a case of Pott’s Spine.

THE PROCEDURE

After the initial workup, which also revealed loculated collection in the left lung and worsening symptoms despite ICD insertion, the patient was posted for therapeutic thoracoscopy and decortication of the left lung. Using 3 ports, 1 – 10mm and 2 – 5mm in 3rd, 5th, 7th inter costal spaces, extensive slough and septations responsible for loculated collection was located and removed. Complete decortication of visceral pleura was performed and haemostasis was achieved. Comprehensive lung expansion was seen intraoperative, after which no. 32 drain was placed in the left lung. The whole procedure was performed without administering a single lung anaesthesia. Patient withstood the procedure very well and the recovery was quite uneventful.

THE RESULT

Post surgery, the patient’s symptoms and overall condition improved significantly. The drain was removed on the 4th postoperative day after lung expansion was seen on consecutive X-rays. He was discharged on the 6th day post-operation. The patient was followed up with no recurrence of symptoms like fever and breathlessness, and is doing well now.

DISCUSSION

Thoracoscopic Decortication is a procedure well established to have distinct advantages over the conventional procedure. As in this case, we have seen excellent recovery with great results and minimum pain. The patient was able to resume day-to-day activities very soon.



Dr. Manmohan Kamat

Dr. Manmohan Kamat

Sr. Consultant
General Surgery
Minimal Access and
Laparoscopic Surgery
Nanavati Super Speciality
Hospital, Mumbai