Abstract
Anterior spinal pathology of the upper thoracic (T2–T4) segment is rare. The surgical approach is still controversial. Anterior week approach with partial osteotomy of the sternum or high latero-posterior thoracotomy are insufficient to approach this segment.
The purpose of this study is to present our experience with sternotomy as a approach in the surgical treatment of anterior spinal pathology to the upper thoracic (T2–T4) segment.
Material and methods: Between 2000–2004 nine patients with anterior spinal pathology in the upper thoracic segment were surgically treated. From all patients 5 were male and 4 female. The age ranged from 52 to 62 years. The anterior spinal pathology localisation was in 5 patients in T2; in 2 pt. in T2 and 2 pt. in both T2 and T3. The diagnosis in all patients was done by protocol wich included: careful neurological examination; standard radiographic films (AP and lateral view); CT; MRI; bone scan and other routine investigations. Neurologic status (deficit) was evaluated by modified Frankel Scale (M.F.S.). There were one patient grade A2; 4 patients with grade B; 3 pt. as a grade 3 and one grade D1. Sternotomy as a approach was used in all patients to expose the upper thoracic (T2–T4) segment. Corpectomy, extirpation of the local tumors mass; decompression of the spinal canal and neural elements was done.
The defect between T1-T3-4 was bridged with three-cortical iliac crest bone graft. In 7 cases fixation with anterior plate was done. Histologically in 2 pt. was found metastasis of carcinoma of thyroid grand foliculocellulare type; in 4 pt. solitary plasmocytoma; in two pt. giant cell tumor and in one patient invasive chondroma. All patients after surgery were transferred to the Oncology Center for other aditional treatment. Neurological recovery was registered in all patients expect one who died 2 months after surgery. The patient with grade A2 and one of grade B recovered to grade D1; one patient of grade B recovered to grade C and two of grade B and patients of grade C and D recovered to grade E. The solid fusion happened in all patient expect one who died.
Conclusion:
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Sternotomy is a safe approach to the upper thoracic T2–T4 segment with possibility of direct visualisation of pathologic process and radical extirpation of the tumorous mass.
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Early decompression of the spinal canal and neural elements by corpectomy and manolatory for neurologic recovery.
The abstracts were prepared by Orah Naor, IOA Co-ordinator and Secretary. Correspondence should be addressed to Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
