Video-Assisted Thoracoscopic Surgery Combined with Posterior Percutaneous Internal Fixation: A Novel Minimally Invasive Approach for Treating Thoracic Spinal Infections

Background: Thoracic spinal infections, such as infectious spondylodiscitis, pose significant challenges, with goals of eradicating infection, preserving neurologic function, and maintaining spinal alignment.The surgical approach for treating thoracic spine infections remains controversial，Video-assisted thoracoscopic surgery (VATS) combined with posterior percutaneous internal fixation offers a minimally invasive alternative for debridement, drainage, and stabilization. Objectives: To assess the efficacy and safety of VATS combined with posterior percutaneous internal fixation in treating thoracic spinal infections, evaluating patient demographics, inflammatory markers, pain levels, kyphotic angles, and clinical outcomes. Study Design :Retrospective observational study . Setting: Department of Orthopedics, Shandong Provincial Public Health Clinical Center. Methods: From January 2022 to January 2025, 39 patients with thoracic spinal infections underwent video-assisted thoracoscopic surgery (VATS) for debridement, drainage, and microbiological culture to confirm causative pathogens, followed by posterior percutaneous internal fixation for stabilization. Patients were selected based on failure of conservative therapy, confirmed by CT and MRI. Both preoperatively and postoperatively, inflammatory markers (CRP 、ESR), Visual Analogue Scale (VAS) scores, complications, and kyphosis angles were monitored. Results: Thirty-nine patients were included, with their demographic characteristics, clinical profiles, and microbiological findings detailed in Table 1. Mean age was 58.28 ± 12.22 years (SD; range: 27–78 years). Gender distribution was relatively balanced (18 females [46.15%]; 21 males [53.85%]). Mean height and weight were 163.77 ± 12.22 cm (range: 106–178 cm) and 66.92 ± 14.81 kg (range: 45–93 kg), respectively.Causative pathogens were identified in 34 cases (culture rate: 87.18%) without prior antibiotic exposure.Pain was significantly alleviated in all cases.The mean preoperative Visual Analogue Scale (VAS) score of the 39 patients was 7.38 ± 1.25, which decreased to 3.15 ± 1.17 one week postoperatively and further reduced to 0.41 ±0.68 one month postoperatively.C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels normalized in 84.61% and 92.3% of Ascending triangle of patients by 3 months post-surgery, respectively. The mean kyphotic angle change was -0.21° ± 1.85°at the final follow-up, indicating no significant progression of sagittal deformity. No surgery-related complications were observed, and no conversions to open spinal surgery were required during the follow-up period. Limitations: Retrospective, single-center design introduces potential bias. Conclusions: VATS combined with posterior percutaneous internal fixation is a safe, effective strategy for thoracic spinal infections, offering high pathogen identification rates, minimal kyphotic changes, and low recurrence, positioning it as a viable alternative to traditional open approaches.