A transsternoclavicular approach for the anterior decompression and fusion of the upper thoracic spine

2005 ◽  
Vol 2 (2) ◽  
pp. 226-229 ◽  
Author(s):  
Mutsuhiro Tamura ◽  
Masashi Saito ◽  
Masafumi Machida ◽  
Keiichi Shibasaki
Keyword(s):  
Thoracic Spine ◽  
Anterior Approach ◽  
Anterior Decompression ◽  
Thoracic Region ◽  
Anatomical Structures ◽  
Content Type ◽  
Upper Thoracic Spine ◽  
Upper Thoracic ◽  
Anterior Decompression And Fusion ◽  
Fine Print

✓ The anterior approach is commonly used to reach the upper thoracic region to achieve decompression and stabilization; however, upper thoracic lesions are difficult to treat because of the regional anatomical structures, and this approach is associated with risks of complication. The authors evaluated the advantages of using a transsternoclavicular approach to aid in treating upper thoracic lesions. The procedure and surgery-related outcomes are discussed.

An anterior approach to spinal pathology of the upper thoracic spine through a partial manubriotomy

2011 ◽  
Vol 15 (5) ◽  
pp. 467-471 ◽  
Author(s):  
Fred C. Lam ◽  
Michael W. Groff
Keyword(s):  
Thoracic Spine ◽  
Anterior Approach ◽  
Surgical Pathology ◽  
Anterior Decompression ◽  
Upper Thoracic Spine ◽  
Perioperative Morbidity ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Upper Thoracic

Surgical pathology in the region of the upper thoracic spine (T1–4) is uncommon compared with other regions of the spine. Often times posterior and posterolateral approaches can be used, but formal anterior decompression often requires a low anterior cervical approach combined with a sternotomy, which yields significant perioperative morbidity. The authors describe a modified low anterior cervical dissection combined with a partial manubriotomy that they have used to successfully access and decompress anterior pathology of the upper thoracic spine. Their modified approach spares the sternoclavicular joints and leaves the sternum intact, decreasing the morbidity associated with these added procedures.

Surgical approach to anterior compression in the upper thoracic spine

2002 ◽  
Vol 97 (3) ◽  
pp. 337-442 ◽  
Author(s):  
Ho Jun Seol ◽  
Chun Kee Chung ◽  
Hyun Jib Kim
Keyword(s):  
Thoracic Spine ◽  
Clinical Status ◽  
Spinal Tumor ◽  
Neurological Deficits ◽  
Content Type ◽  
Upper Thoracic Spine ◽  
Metastatic Spinal Tumor ◽  
Upper Thoracic ◽  
Fine Print

Object. The anterior upper thoracic spine (T1–3) is difficult to access because most neurosurgeons are unfamiliar with the anatomy. This study was performed to evaluate the different surgical options by retrospectively analyzing data on operations performed for anterior upper thoracic compression at the authors' institution. Methods. Eighteen patients underwent surgery between November 1993 and May 2001. There were eight men and 10 women; their mean age was 55 years (range 28–80 years). All patients presented with pain and/or neurological deficits. The causes of anterior compression were diverse, although metastatic spinal tumor was most common. The approach chosen was primarily dictated by the axial involvement of the lesion. Anterior approaches, mainly the transmanubrium approach, were performed in six and posterior approaches in 12. In all cases except one, in which only an iliac bone graft was placed, instrumentation was used. The mean follow-up period was 11.4 months (range 1–57 months). One postoperative death occurred. Postoperative follow-up imaging studies, especially plain radiography, demonstrated no instrumentation failure. Improvement was shown in eight patients, an aggravation of symptoms in one, and stable clinical status in eight. Conclusions. Decompression may be achieved on the anterior side of the upper thoracic spine if the operative approach is scrupulously chosen; this choice involves consideration of the locations of the lesion, the nature of the primary disease, and the surgery-related risk.

scholarly journals Anterior Decompression by Sternum Splitting Approach for Kyphosis of Upper Thoracic Spine Caused by Tuberculous Spondylitis: A Case Report

2004 ◽  
Vol 53 (2) ◽  
pp. 281-283
Author(s):  
Kazushi Nakamura ◽  
Kazunori Yone ◽  
Kyoji Hayashi ◽  
Toshihiko Izumi ◽  
Shunji Matsunaga ◽  
...  
Keyword(s):  
Case Report ◽  
Thoracic Spine ◽  
Anterior Decompression ◽  
Tuberculous Spondylitis ◽  
Upper Thoracic Spine ◽  
Upper Thoracic

Anterior decompression for ossification of the posterior longitudinal ligament of the cervical spine

1981 ◽  
Vol 55 (1) ◽  
pp. 108-116 ◽  
Author(s):  
Hiroshi Abe ◽  
Mitsuo Tsuru ◽  
Terufumi Ito ◽  
Yoshinobu Iwasaki ◽  
Mitsuyuki Koiwa
Keyword(s):  
Cervical Spine ◽  
Marked Improvement ◽  
Anterior Approach ◽  
Posterior Longitudinal Ligament ◽  
Long Bone ◽  
Anterior Decompression ◽  
Content Type ◽  
Operative Results ◽  
Vertebral Bodies ◽  
Anterior Decompression And Fusion

✓ Anterior decompression and fusion for treating ossification of the posterior longitudinal ligament of the cervical spine was performed in 12 patients. The central part of the vertebral body and the ossified area of the posterior longitudinal ligament were removed by means of a microrongeur and an air drill. The defect was filled with a long bone graft taken from the ilium. The operative results were excellent. Marked improvement of radicular and spinal cord signs was seen in all 12 cases. Three vertebral bodies were fused in one case, four in nine cases, and five in two cases. The highest level of fusion was C-2 and the lowest was T-1. It is considered that any ossification of the ligament below the C-2 level can be removed via an anterior approach as long as no more than five vertebral bodies are involved. Spinal computerized tomography was valuable in providing more detailed information about the stenotic spinal canal and the shape of the ossified ligament.

scholarly journals Treatment of Anterior Approach to Upper Thoracic Spine Using Total Sternum Splitting

2012 ◽  
Vol 61 (3) ◽  
pp. 513-517
Author(s):  
Shogo Tahata ◽  
Koji Akasaki ◽  
Taka-aki Sagara ◽  
Yosuke Kawatani ◽  
Hiroyuki Watanabe ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Anterior Approach ◽  
Upper Thoracic Spine ◽  
Upper Thoracic

Effects of pilot hole preparation technique on pedicle screw fixation in different regions of the osteoporotic thoracic and lumbar spine

2005 ◽  
Vol 3 (5) ◽  
pp. 364-370 ◽  
Author(s):  
Jonathan J. Carmouche ◽  
Robert W. Molinari ◽  
Tad Gerlinger ◽  
John Devine ◽  
Troy Patience
Keyword(s):  
Lumbar Spine ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
Preparation Technique ◽  
Content Type ◽  
Pilot Hole ◽  
Pullout Resistance ◽  
Insertional Torque ◽  
Upper Thoracic ◽  
Fine Print

Object. The authors evaluated the effects of pilot hole preparation technique on insertional torque and axial pullout resistance in osteoporotic thoracic and lumbar vertebrae. Methods. Using a probe technique and fluoroscopy, 102 pedicle screws were placed in 51 dual-energy x-ray absorptiometry—proven osteoporotic thoracic and lumbar levels. Screws were inserted using the same-size tapping, one-size-under tapping, or no-tapping technique. Insertional torque and axial pullout resistance were measured. Analysis of variance, Fisher exact test, and regression analysis were performed. Same-size tapping decreased pullout resistance in the lumbar spine. There was no effect on pullout resistance in the thoracic spine. Pullout resistance values were lower for all insertion techniques in the upper thoracic spine. Insertional torque and bone mineral density correlated with pullout resistance in the thoracic and lumbar spine. Conclusions. Tapping decreased pedicle screw pullout resistance in the osteoporotic human lumbar spine, although it did not affect pullout strength in the thoracic spine. Tapping decreased insertional torque in upper thoracic levels. Surgeons should optimize overall construct rigidity when placing thoracic pedicle screws in patients with spinal segment osteoporosis.

“Trap door” exposure of the cervicothoracic junction

1994 ◽  
Vol 80 (2) ◽  
pp. 338-341 ◽  
Author(s):  
Jules M. Nazzaro ◽  
Ehud Arbit ◽  
Michael Burt
Keyword(s):  
Anterior Approach ◽  
Median Sternotomy ◽  
Sternoclavicular Joint ◽  
Sternocleidomastoid Muscle ◽  
Cervicothoracic Junction ◽  
Content Type ◽  
Upper Thoracic Spine ◽  
Trap Door ◽  
Anterolateral Thoracotomy ◽  
Upper Thoracic

✓ This report describes a “trap door” exposure of the cervicothoracic junction. The method combines a standard anterior approach to the spine along the medial border of the sternocleidomastoid muscle with both a partial median sternotomy and an anterolateral thoracotomy. Transection of the clavicle is not required and the sternoclavicular joint is preserved. With this method, all important ventral paravertebral vessels, nerves, and associated soft tissue are fully identified and readily mobilized as needed. The method provides full bilateral anterior exposure from the C-4 through at least the T-3 vertebral levels, as well as unilateral anterolateral access to the upper thoracic spine.

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