Cervical dislocation following fusion of the upper thoracic spine for scoliosis. A case report.

Righesso

Teles

2011

SPI

Object The purpose of this study was to present straightforward preoperative methods to define the need for manubriotomy in the anterior surgical approach to the cervicothoracic junction. Methods Preoperative MR imaging and CT scanning studies were performed in all patients. The CT images with sagittal reconstructions including the manubrium were done to apply the so-called surgeons' view line. This line is parallel to the inferior plateau of the superior healthy vertebrae or the vertebrae above the herniated intervertebral disc, and the decision concerning the need for manubriotomy depends on the correlation between this line and the manubrium. Results Preoperative planning of the need for manubriotomy was correct in all cases. Manubriotomy was never performed in C-7 corpectomy or C7–T1 discectomy cases; nevertheless, manubriotomy was needed in half of the cases when the T-1 corpectomy was the lowest level to be resected (8 cases), and in 4 cases the lowest level to be approached was T-2. The mean surgical time, bleeding volume, postoperative pain intensity, and length of hospital stay were less in the cervicotomy than in the manubriotomy group. Conclusions By using the surgeons' view line and its correlation with the manubrium, the need for manubriotomy can be predicted without compromising decompression and reconstruction. The statistical differences observed in the surgical variables between the manubriotomy and cervicotomy cases justified the use of preoperative evaluation of the need for manubriotomy as an aid to surgical planning and to give the patient and family realistic expectations about the surgery.

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Anterior approach to the cervicothoracic junction: proposed indication for manubriotomy based on preoperative computed tomography findings

Righesso

Teles

2011

SPI

“…Although this approach is not very invasive, it does not allow good visualization and anterior reconstruction below T1, which results from the patient's anatomical characteristics, such as marked junctional kyphosis, congenital high sternum, short neck or large shoulders 7,15,24,34 . The need to perform or not the manubriotomy depends on the level of vertebral lesion and the vertebral body angulations, the latter variable being the most important.…”

Section: Discussionmentioning

confidence: 99%

“…Progressive instability of this area ultimately leads to kyphosis and spinal cord compression, as neurological involvement is a common complication with rate as high as 80% 4,5 . The indication of C7-T1 laminectomies to treat these lesions had two limitations; first, adequate ventral spinal cord decompression is impossible and, second, the procedure itself can destabilize the cervicothoracic region, besides the fact that fixation is difficult [6][7][8] . The surgical treatment goals are neural decompression, immediate stabilization, restoration of anatomical spinal alignment and early rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Anterior approach to the cervicothoracic junction: case series and literature review

Righesso²,

Filho

et al. 2009

Coluna/Columna

Objectives: the authors report their experience with the anterior approach to the cervicothoracic junction at C7 to T4 vertebral bodies, how the radiological investigation was performed in order to define the need for manubriotomy, how was the surgical pitfalls and the clinical evaluation. Methods: prospective cohort study with 14 patients who underwent an anterior approach to the cervicothoracic surgery during the period of January 1996 to January 2009. The patients underwent radiographic evaluation with computed tomography and magnetic resonance before surgery in order to identify when the manubriotomy was necessary. The surgery was usually performed from the left side through an anterior Smith-Robinson approach and manubriotomy when necessary. Mesh and cervical plate system were used for stabilization when corpectomy was performed. Nevertheless, in RESUMOObjetivo: relatar a experiência dos autores no acesso anterior da junção cervicotorácica C7 a T4, em relação à definição de quando é necessária a realização da manubriotomia, quais as particularidades desta cirurgia e a avaliação dos resultados. the cases with discal herniation C7-T1, the reconstruction was done with PEEK and cervical plate system. Results: the mean age was 63 years old (range, 30-77 years) and seven of the patients were men. The majority of cases had metastatic disease (n=8) or disc herniation (n=4). There were two complications related to the surgical procedures: one patient with dysphonia caused by a local hematoma and other one with lung infection. The mean surgical time, bleeding volume, pain intensity, medication intake and length of hospital stay were lower in the cases in which manubriotomy was not necessary. Conclusions: the anterior approach to the cervicothoracic junction is effective and presents low morbidity rate. In cases of injuries involving the C7 vertebral body and C7-T1 intervertebral disc herniation, a transcervical approach without the manubriotomy was indicated; when a T1 and/or T2 corpectomy was necessary, the transmanubrial approach usually was necessary in order to provide a good working space to perform a corpectomy and reconstruction. Performing manubriotomy increases surgical time, bleeding, pain intensity, analgesic drugs intake and the length of hospital stay. KEYWORDS:

“…It is susceptible to injury because of the weight transfer from the anterior column to the posterior column 2 and the vertebral index decreases from C6 to T1 vertebrae, causing added stress to be applied to the more narrow and thinner vertebrae 3 . Several studies demonstrate that surgical procedures in the cervicothoracic junction can destabilize this region, mainly laminectomies at C7-T1 4,5 and spinal fusions ending at this junction 5,6 . Pathological processes such as tumors, trauma, degeneration and infection, which usually occur in the anterior segment of the vertebrae, frequently determine instability of this segment 7 .…”

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confidence: 99%

Anterior surgical management of the cervicothoracic junction lesions at T1 and T2 vertebral bodies

Righesso²,

Pinto-Filho

et al. 2008

Arq. Neuro-Psiquiatr.

-Lesions of the cervicothoracic junction have a high propensity for causing instability and present unique challenges in the surgical treatment. Several surgical approaches to this region have been described in the literature. We report our experience in the surgical treatment of six patients with unstable lesions involving the cervicothoracic junction at T1 and T2 vertebral bodies. The patients underwent an anterior left Smith-Robinson approach and manubriotomy. Mesh and cervical plate system were used for stabilization and reconstruction of the region. No complication related to the surgical procedure was observed. In our experience, in injuries involving the T1 and T2 vertebral bodies, the transmanubrial approach offers good working room to remove the lesions and anterior reconstruction.KEY WORDS: spine, cervicothoracic junction, instability, surgical treatment. Manejo cirúrgico via anterior das lesões da junção cérvico-torácica nos corpos vertebrais de T1 e T2Resumo -Lesões da junção cérvico-torácica têm alta tendência em causar instabilidade e apresentam grandes desafios ao tratamento cirúrgico. Diversas abordagens cirúrgicas a esta região foram descritas na literatura. Relatamos nossa experiência no tratamento cirúrgico de seis pacientes com lesões instáveis envolvendo a junção cérvico-torácica em corpos vertebrais de T1 e T2. Os pacientes foram submetidos a uma abordagem anterior de Smith-Robinson pela esquerda e manubriotomia. Mesh e placa cervical foram utilizados para estabilização e reconstrução da região. Nenhuma complicação relacionada ao procedimento cirúrgico foi observada. Em nossa experiência, em lesões que envolvem os corpos vertebrais de T1 e T2, a abordagem transmanubrial oferece bom campo de trabalho para remoção das lesões e estabilização anterior.