Anterior transsternal approach for a lesion in the upper thoracic vertebral body

Object. Access to the upper thoracic vertebrae has been hampered by numerous anatomical structures and is further impaired by the transition from cervical lordosis to thoracic kyphosis. Therefore, the authors endeavored to study an anterior transsternal approach for upper thoracic disease (T1-4). Methods. Fifty-four patients with upper thoracic disease underwent anterior decompression and fusion with sternotomy. Ages in the 33 men and 21 women ranged from 37 to 69 years (average 49 years). Before surgery, there were 7 patients with Frankel Grade B function, 17 with Grade C, 21 with Grade D, and 9 with Grade E. For a T-1 and T-2 lesion, the authors used "inside window of the brachiocephalic artery": the brachiocephalic artery and right arteria carotis communis were retracted to the right, and the tracheoesophageal sheath was retracted to left. For a T-3 and T-4 lesion, the authors used the "outside window of the brachiocephalic artery": the trachea, esophagus, and brachiocephalic artery were retracted to the left, the proximal portion of the right innominate vein was retracted to the right, and the left innominate vein was retracted inferolaterally. The patients were followed up for 24-48 months. Results. The surgery was successful. The operation time was 120-150 minutes, and bleeding during the operation was 300-800 ml. After surgery, pain resolved in all patients, and improvement in motor deficits was noted in those who had presented with radiculopathy or myelopathy. Postoperative histological examinations showed that 33 patients had tuberculosis, 14 had metastatic neoplasm, 5 had eosinophilic granuloma, and 2 had traumatic fracture. Four patients died of systemic metastatic cancer between 10 and 21 months after surgery. There was no serious approach-related postoperative complication and no breakage of screws or failure of the internal fixation during follow-up. Conclusions. Upper thoracic vertebrae can be exposed with sternotomy. This approach can provide excellent access to a lesion. (DOI: 10.3171/2010.4.SPINE09808)