Once the selleck inhibitor 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 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. Average blood loss increases with the operative time and addition of an additional procedure.

Better view provided by thoracoscopy and its preservation of wall structures (less extensive tissue dissection) probably are the explanations for less bleeding. Blood loss was comparative to other series of VATS in tuberculosis spine [13, 15, 16], except studies by Jayaswal et al. [12] and Kandwal et al. [17] where they used spinal instrumentation for stabilization in addition to the debridement. One of the major reported advantages of VATS was the reduction in postoperative hospital stay, and this was also observed in our series [22, 23]. Postoperative stay was less than reported by thoracotomy patients in other studies [23], which is a major consideration in developing countries with a high patient load in tertiary care hospitals.

Table 3 Comparison of mean duration of surgery, average blood loss, and postoperative hospital stay with other studies. One of the major goals of surgery was to achieve adequate neurological decompression through VATS in the present study. The decompression was adequate as indicated by the neurological recovery in all our cases. Our results are in accordance with available literature showing neurological recovery varying from 82 to 95% recovery of ambulatory status [12, 13, 15�C17]. In a retrospective study done by Jayaswal et al. (2007), postoperatively 17 of the 18 patients with preoperative neurologic deficit attained ambulatory status and all patients showed improvement on the Frankel scale, with Grade C in one patient, Grade D in 10 patients, and Grade E in 12 patients [12].

In a series by Kapoor et al. (2005) of 16 patients, 14 (88%) had good neurologic recovery (improvement by 2-3 grades). In one patient, Dacomitinib thoracoscopy was abandoned, and open thoracotomy was performed. Another patient did not recover and underwent anterolateral decompression after 10 weeks [16]. In another series of 30 patients by Kapoor et al. (2012), all patients improved neurologically on a mean followup of 80 months. No patient had neurological deterioration and all of them regained ambulatory power with no cases of recurrence of tuberculosis [13]. In a series by Huang et al.