Document Detail

Anterior thoracic corpectomy without sternotomy: a strategy for malignant disease of the upper thoracic spine.
MedLine Citation:
PMID:  9309285     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: With increasing frequency, spine surgeons are being asked to provide decompression and stabilization in patients with spinal metastases. While no region of the spine is easily treated, the upper thoracic spine is perhaps the least accessible. Traditional approaches to this region involve either thoracotomy or at least limited sternotomy. The authors present an approach to anterior pathology of the upper thoracic spine that obviates the need for sternotomy. METHODS: Within the past two years, two patients with cervicothoracic metastases underwent anterior decompression and fusion without sternotomy. In both patients, the bodies of C7, T1, and T2 were removed. While both patients were prepared and draped for sternotomy, each required a neck dissection only. In both patients, left-sided incisions were made along the leading edge of the sternocleidomastoid. The platysma was divided with the overlying skin. With further dissection, the strap muscles were tagged and divided approximately one centimeter above their sternal attachments. The loose areolar tissue of the superior mediastinum was then bluntly dissected. Along the entire length of the incision, the vascular plane medial to the carotid sheath was developed to facilitate exposure of the anterior spine. A Farley-Thompson retractor system was then employed to retract and protect the superior mediastinal structures. With this exposure, corpectomies were carried out using a high speed drill. Fusion was accomplished through insertion of Steinmann pins into the adjacent intact bodies above and below. This was followed by application of methyl methacrylate. Both patients had immediate postoperative stability with preservation of spinal cord function. Both patients subsequently underwent removal of dorsally located tumor with posterior fusion. CONCLUSIONS: The goal of cancer surgery is to provide for increased functional survival without undue morbidity. The authors feel that when possible, the pain of sternal and clavicular osteotomies should be avoided. The described approach works well in conjunction with a methyl methacrylate/Steinmann pin construct. Because of the intact sternum, the surgeon has a downward angle to access the superior endplate of T3. With adequate soft tissue dissection and retraction as described, however, T3 and perhaps even T4 are easily accessible. While this downward angle would likely not permit an anterior plating procedure, it lends itself nicely to Steinmann pin/methyl methacrylate fusion and spares the patient the pain and potential morbidity of sternotomy.
C H Comey; M R McLaughlin; J Moossy
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Acta neurochirurgica     Volume:  139     ISSN:  0001-6268     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  1997  
Date Detail:
Created Date:  1997-11-13     Completed Date:  1997-11-13     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  AUSTRIA    
Other Details:
Languages:  eng     Pagination:  712-8     Citation Subset:  IM    
Department of Neurosurgery, University of Pittsburgh, PA, USA.
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MeSH Terms
Breast Neoplasms / diagnosis,  surgery
Carcinoma, Ductal, Breast / diagnosis,  secondary,  surgery
Carcinoma, Squamous Cell / diagnosis,  secondary,  surgery
Cervical Vertebrae / pathology,  surgery
Decompression, Surgical / methods*
Follow-Up Studies
Head and Neck Neoplasms / diagnosis,  surgery
Magnetic Resonance Imaging
Middle Aged
Postoperative Complications / diagnosis
Spinal Cord Compression / surgery*
Spinal Fusion / methods
Spinal Neoplasms / diagnosis,  secondary*,  surgery
Thoracic Vertebrae / pathology,  surgery*

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