Transaxillary left-sided minimally invasive approach for upper thoracic vertebral resection and reconstruction at T2–T3 levels: a case report

Abstract

Surgical procedures of the upper thoracic spine are often challenging due to the anatomical topography of the thoracic spine. The most common approaches include the anterior supramanubrial, transmanubrial, and transsternal as well as the posterior approach with costotransversectomy. Recently, an infraaxillary right-sided thoracotomy was described for upper thoracic vertebral decompression and fusion at T2-T6 levels. In the current case, we report a transaxillary left-sided mini-thoracotomy for thoracic vertebral resection and reconstruction at T2-T3 levels. The incision enabled safe and uncomplicated surgery of the upper thoracic spine providing excellent exposure of the surgical site. Compared with the common incisions applied for surgery of the upper thoracic spine, surgical trauma is minimized without the need of sternotomy, division of the back muscles or resecting a rib. Moreover, anatomical critical structures such as the common carotid trunk, the jugular vein, or trachea are not encountered, hence increasing the safety of the procedure.

Abordaje torácico anterior infraclavicular para el acceso a las vértebras torácicas superiores: reporte de un caso y descripción de una nueva técnica quirúrgica

“…At that level a resection of the 4 th arch is performed, therefore the anterior face is exposed to the vertebral bodies from T2-T6. 19 The second surgical technique consists in a left axillary approach at the level of the second costal arch with an incision of 4 cm of length, creating a safe access route to the anterior and lateral face of T2-T4 vertebrae, allowing the vision of all the structures surrounding the vertebral body, 20 it is important to mention that both approaches avoid the high complexity and comorbidities of a sternotomy, which confirms by means of adequate familiarization with the approach or the help of a thoracic surgeon, it can be performed either right or left depending on the pathology of each patient. Based on the above, it is likely that a high right infraclavicular anterior thoracic route such as the one described in our case is less complex for the thoracic surgeon or spinal surgeon since we avoid dissection of the mediastinum.…”