Table of Contents Author Guidelines Submit a Manuscript
BioMed Research International
Volume 2016, Article ID 4854217, 9 pages
http://dx.doi.org/10.1155/2016/4854217
Research Article

Mini Transsternal Approach to the Anterior High Thoracic Spine (T1–T4 Vertebrae)

1Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK
2Department of Vascular Surgery, King’s College Hospital NHS Foundation Trust, London, UK
3Faculty of Medicine, Imperial College London, London, UK
4Department of Neurosurgery, “Sapienza” University of Rome, Rome, Italy

Received 27 October 2015; Accepted 14 March 2016

Academic Editor: William B. Rodgers

Copyright © 2016 Christian Brogna et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. The anterior high thoracic spine is one of the most complex segments to be accessed surgically due to anatomical constraints and transitional characteristics. We describe in detail the mini transsternal approach to metastatic, infective, traumatic, and degenerative pathologies of T1 to T4 vertebral bodies. We analyse our surgical series, indications, and outcomes. Methods. Over a 5-year period 18 consecutive patients with thoracic myelopathy due to metastatic, infective, traumatic, and degenerative pathologies with T1 to T4 vertebral bodies involvement received a mini transsternal approach with intraoperative monitoring. Frankel scoring system was used to grade the neurological status. Results. Mean follow-up was 40 months. 78% patients improved in Frankel grade after surgery and 22% patients remained unchanged. Average operation time was 210 minutes. There were no intraoperative complications. One patient developed postoperative pneumonia successfully treated with antibiotics. Conclusion. The mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions affecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca. This approach overcomes the anatomical constraints of this region and provides adequate room for optimal reconstruction and preservation of spinal alignment in the cervicothoracic transition zone with good functional patient outcomes.