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Mini Transsternal Approach to the Anterior High Thoracic Spine (T1-T4 Vertebrae).

Brogna C, Thakur B, Fiengo L, Tsoti SM, Landi A, Anichini G, Vergani F, Malik I - Biomed Res Int (2016)

Bottom Line: One patient developed postoperative pneumonia successfully treated with antibiotics.Conclusion.The mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions affecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.

ABSTRACT
Purpose. The anterior high thoracic spine is one of the most complex segments to be accessed surgically due to anatomical constraints and transitional characteristics. We describe in detail the mini transsternal approach to metastatic, infective, traumatic, and degenerative pathologies of T1 to T4 vertebral bodies. We analyse our surgical series, indications, and outcomes. Methods. Over a 5-year period 18 consecutive patients with thoracic myelopathy due to metastatic, infective, traumatic, and degenerative pathologies with T1 to T4 vertebral bodies involvement received a mini transsternal approach with intraoperative monitoring. Frankel scoring system was used to grade the neurological status. Results. Mean follow-up was 40 months. 78% patients improved in Frankel grade after surgery and 22% patients remained unchanged. Average operation time was 210 minutes. There were no intraoperative complications. One patient developed postoperative pneumonia successfully treated with antibiotics. Conclusion. The mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions affecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca. This approach overcomes the anatomical constraints of this region and provides adequate room for optimal reconstruction and preservation of spinal alignment in the cervicothoracic transition zone with good functional patient outcomes.

No MeSH data available.


Related in: MedlinePlus

(a) Case illustration 4: intraoperative picture under the microscope showing the ministernotomy and the direct view of the anterior high thoracic vertebral bodies achievable with a mini transsternal approach. (b) Case illustration 4: intraoperative photo of the placement of the mesh filled with autologous iliac bone. The mini transsternal approach allows an excellent route for anterior spine reconstruction.
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fig8: (a) Case illustration 4: intraoperative picture under the microscope showing the ministernotomy and the direct view of the anterior high thoracic vertebral bodies achievable with a mini transsternal approach. (b) Case illustration 4: intraoperative photo of the placement of the mesh filled with autologous iliac bone. The mini transsternal approach allows an excellent route for anterior spine reconstruction.

Mentions: A 39-year-old female with ankylosing spondylitis and previous C5/6 anterior cervical fixation and fusion presented with a progressive flexion deformity of the neck and weakness of the arms and legs. CT scan showed a C6/7 subluxation. The patient had an extensive anterior cervical fixation via a mini transsternal approach, removal of previous C5/6 fixation, C6/7 discectomy with iliac crest bone graft, and insertion of a C5-T2 anterior plate and application of a cervical halo. At last follow-up her Frankel grade D remained unchanged.


Mini Transsternal Approach to the Anterior High Thoracic Spine (T1-T4 Vertebrae).

Brogna C, Thakur B, Fiengo L, Tsoti SM, Landi A, Anichini G, Vergani F, Malik I - Biomed Res Int (2016)

(a) Case illustration 4: intraoperative picture under the microscope showing the ministernotomy and the direct view of the anterior high thoracic vertebral bodies achievable with a mini transsternal approach. (b) Case illustration 4: intraoperative photo of the placement of the mesh filled with autologous iliac bone. The mini transsternal approach allows an excellent route for anterior spine reconstruction.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4863085&req=5

fig8: (a) Case illustration 4: intraoperative picture under the microscope showing the ministernotomy and the direct view of the anterior high thoracic vertebral bodies achievable with a mini transsternal approach. (b) Case illustration 4: intraoperative photo of the placement of the mesh filled with autologous iliac bone. The mini transsternal approach allows an excellent route for anterior spine reconstruction.
Mentions: A 39-year-old female with ankylosing spondylitis and previous C5/6 anterior cervical fixation and fusion presented with a progressive flexion deformity of the neck and weakness of the arms and legs. CT scan showed a C6/7 subluxation. The patient had an extensive anterior cervical fixation via a mini transsternal approach, removal of previous C5/6 fixation, C6/7 discectomy with iliac crest bone graft, and insertion of a C5-T2 anterior plate and application of a cervical halo. At last follow-up her Frankel grade D remained unchanged.

Bottom Line: One patient developed postoperative pneumonia successfully treated with antibiotics.Conclusion.The mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions affecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.

ABSTRACT
Purpose. The anterior high thoracic spine is one of the most complex segments to be accessed surgically due to anatomical constraints and transitional characteristics. We describe in detail the mini transsternal approach to metastatic, infective, traumatic, and degenerative pathologies of T1 to T4 vertebral bodies. We analyse our surgical series, indications, and outcomes. Methods. Over a 5-year period 18 consecutive patients with thoracic myelopathy due to metastatic, infective, traumatic, and degenerative pathologies with T1 to T4 vertebral bodies involvement received a mini transsternal approach with intraoperative monitoring. Frankel scoring system was used to grade the neurological status. Results. Mean follow-up was 40 months. 78% patients improved in Frankel grade after surgery and 22% patients remained unchanged. Average operation time was 210 minutes. There were no intraoperative complications. One patient developed postoperative pneumonia successfully treated with antibiotics. Conclusion. The mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions affecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca. This approach overcomes the anatomical constraints of this region and provides adequate room for optimal reconstruction and preservation of spinal alignment in the cervicothoracic transition zone with good functional patient outcomes.

No MeSH data available.


Related in: MedlinePlus