criteria for fusion assessment [14]. Final functional outcome was assessed by modified Kirkaldy-Willis criteria [18]. 3. Results Patients inhibitor Rapamycin were suffering from the symptomatology of the TB with a mean duration of 8.44��3 months (range: 5�C12 months). All the patients (n = 09) received antituberculous treatment (ATT) for a period of 3-4 weeks minimum before surgery and then postoperatively. The total duration of ATT was 12 months. The indication for surgery using VATS was failure to respond to chemotherapy (n = 01), neurological deficit not responding to chemotherapy (n = 07), and doubtful diagnosis (n = 01). Using VATS, debridement, drainage of prevertebral and paravertebral abscess, and decompression of cord were done in six patients; debridement, drainage, decompression, and reconstruction with bone graft were done in one patient; and debridement, drainage, decompression, reconstruction with bone graft, and minithoracotomy were done in two patients.

Sufficient tissue for histopathological examination was obtained and the clinical diagnosis of tuberculosis of spine was confirmed by pathologists in all the cases. The average operative time was 140.88 �� 20.09 minutes (range: 105�C165 minutes), average blood loss was 417.77 �� 190.90mL (range: 220�C730mL), and average hospital stay was 5.77 �� 0.97 days (range: 4�C7 days). As per Frankel’s grading, 7 patients had Grade A neurological involvement preoperatively, which improved at subsequent followups (Table 1). Table 1 Neurological improvement as per Frankel’s grading. Radiographs of the spine revealed wedge collapse with contagious involvement in all patients.

Average vertebral height loss, deformity angle, and kyphotic angle initially were 0.48, 11.8��, and 24.2��, respectively; the final values were 01, 22��, and 37��, respectively. As per CT the average percentage canal encroachment was 52.7% at initial presentation which improved to 10% at the time of final followup; it also revealed that fusion was present in 75% of the patients at their final followup. On MRI, all patients showed paradiscal and contiguous involvement of vertebrae; average vertebrae involvement per patient was 2.88 at presentation and 2.33 at the time of final followup. Paravertebral collection and subligamentous spread were seen in all patients at initial presentation, with an average vertebral extent of paravertebral soft tissue collection and subligamentous spread as 4.

3 vertebrae each initially, which dropped to 2.7 and 1 vertebrae, respectively, at time of final followup. The mean preoperative kyphosis angle in patient without (n = 6) and with (n = 3) bone graft was 25�� and 23�� and at time of final followup was 41�� and 24��, respectively. Two of the six patients without bone grafting achieved fusion at six months and Brefeldin_A another four at 12 months. Eck et al.