Anterior thoracic corpectomy without sternotomy: A strategy for malignant disease of the upper thoracic spine

Comey, Christopher H.; McLaughlin, Mark R.; Moossy, John

doi:10.1007/bf01420043

Cited by 30 publications

(24 citation statements)

References 16 publications

(22 reference statements)

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“…Despite these limitations, the authors of several small case series have described a suprasternal approach to the upper thoracic spine. 3,[5][6][7] The anatomical constraints of this exposure have been elegantly described in studies by Gieger, et al, and Comey, et al These authors emphasized the importance of thorough knowledge of the regional anatomy, especially of the recurrent laryngeal nerves and thoracic ducts. 5,6 Therefore a left-sided approach was preferentially used whenever possible.…”

Section: Discussionmentioning

confidence: 99%

“…Geiger, et al, 6 and Comey, et al, 5 have discussed the need to review preoperative imaging studies to determine the feasibility of the approach. Sharan and colleagues 12 conducted a review of 103 patients who underwent MR imaging of the cervicothoracic junction.…”

Section: Discussionmentioning

confidence: 99%

“…This restriction of the angle of approach has led some authors to the conclusion that anterior fixation of this region is not feasible. 5 Pointillart and colleagues 10 have recently presented two cases in which anterior fixation of the upper thoracic spine was performed by placing instrumentation via a low cervical approach. The description was presented in abstract form, however, and details are not currently available.…”

Section: Discussionmentioning

confidence: 99%

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Anterior cervicothoracic junction corpectomy and plate fixation without sternotomy

Resnick¹

2002

FOC

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Object Exposure of the lower cervical and upper thoracic spinal regions through a cervical incision without sternotomy has been described in cases of anterior decompression and methylmethacrylate vertebral body reconstruction. The use of anterior instrumentation and structural bone grafts in this procedure has not been well described. Methods Twenty-one patients underwent anterior cervicothoracic decompression, fusion, and fixation via a low cervical approach. Eight of these patients underwent lower cervical or upper thoracic corpectomy (C7–T4) through the cervical incision. The decompressive procedure was followed by placement of an allograft bone strut and an anterior locking plate system. No patient developed new neurological deficit related to the spinal cord or exiting nerve roots. Three of four patients with preoperative neurological deficits improved dramatically. Two patients developed recurrent laryngeal nerve palsy, of which one was permanent. There was one case of instrumentation-related failure, and two patients developed a superficial wound infection related to a posterior incision made as part of a 360° fusion. Patients were followed for a mean of 18.5 months (range 2–30 months). Two patients died (of metastatic cancer, and a motor vehicle accident, respectively) during the follow-up period. Conclusions Anterior decompression, fusion, and fixation is feasible via a cervical incision. This procedural approach spares the patient the morbidity associated with sternotomy or the lateral extracavitary approach. A thorough preoperative assessment of mediastinal anatomy is essential for the safe execution of these procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anterior cervicothoracic junction corpectomy and plate fixation without sternotomy

Resnick¹

2002

FOC

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“…A wide frontal exposure is required to see the upper and lower vertebrae when it is necessary to perform decompression and stabilization in this region (15,20). It is difficult to perform surgical interventions in this region due to the presence of large veins in the vicinity and obstructed vision caused by the sternum and clavicle (6). Therefore, many interventions including median sternotomy have been recommended.…”

Section: Introductionmentioning

confidence: 99%

Results of transsternal approach to the cervicothoracic junction lesions

Dalbayrak¹,

Yaman²,

Yılmaz³

et al. 2014

Turkish Neurosurgery

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AIm: Surgery for lesions involving the anterior column of the cervicothoracic junction is still challenging. The median transsternal approach provides a direct approach to this junction. The aim of this study was to present the results of cases operated using the median transsternal approach. mATERIAL and mETHods: There were 8 cases (7 males, 1 female) aged between 18-39 (mean 28.2) years. The compression to the spinal cord was secondary to trauma in 3 cases, infection in 3 cases, and tumor in 2 cases. REsuLTs:Median sternotomy was performed from the right side in 6 cases, and the left side in 2 cases. 14 level corpectomies were performed in 8 cases. Reconstructions were performed using a fibula allograft in 6 cases, and an iliac autograft in 2 cases. The mean follow-up duration was 104 months. A progressive delayed kyphosis requiring posterior stabilization occurred in one case. Postoperative neurological evaluation revealed improvement in 6 cases, and no change in 2 cases. CoNCLusIoN:Median sternotomy is an appropriate and safe approach for selected cases with lesions involving the anterior column of the cervicothoracic junction. The sternal-splitting approach remains the best method for equal exposure of the anterior thoracic and cervical spine from C4 to Th4 vertebrae through a single incision.

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“…From the spinal and cardiothoracic literature, however, it is clear that splitting the sternum or resecting part of clavicle might lead to some complications, such as chronic pain, pneumothorax, infection, sternal dehiscence, nonunion of the clavicle, pseudarthrosis, and instability of the sternoclavicular joint [1,5,7,13,20,22].…”

Section: Introductionmentioning

confidence: 99%

Mini-open anterior approach to the cervicothoracic junction: a cadaveric study

et al. 2013

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Purpose To investigate the feasibility of mini-open anterior approach to the cervicothoracic junction (CTJ) in cadaveric specimens. Methods Four adult fresh-frozen cadaveric specimens were used for this study. On the cadaveric specimen, an osteotomy window was made in manubrium sterni to remove the bony obstacle. To bypass the vital vascular and neural structures over the operative field, we used the surgical corridor which was located medially by the brachiocephalic artery and laterally by the right brachiocephalic vein, or in combination with another surgical corridor between the ascending aorta and the superior vena cava. And we used a special self-retaining retractor system and an endoscope to facilitate the procedures. Results Surgical procedures performed on the four freshfrozen cadaveric specimens to expose the CTJ through mini-open anterior approach were successful. The anterior surface of C6-T5 could be exposed, allowing complete decompression and application of locking plate and screws. The most caudal accessible vertebral body was T5 vertebral body in our study. Conclusion It is feasible to expose the CTJ through this mini-open anterior approach.

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Anterior thoracic corpectomy without sternotomy: A strategy for malignant disease of the upper thoracic spine

Cited by 30 publications

References 16 publications

Anterior cervicothoracic junction corpectomy and plate fixation without sternotomy

Anterior cervicothoracic junction corpectomy and plate fixation without sternotomy

Results of transsternal approach to the cervicothoracic junction lesions

Mini-open anterior approach to the cervicothoracic junction: a cadaveric study

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