Anterior transsternal or anteriorlateral transthoracic approach for upper thoracic vertebral tuberculosis

English Keywords:Upper thoracic spine tuberculosis  Anterior transsternal approach  Anteriorlateral high transthoracic approach

English Abstract:

  【Abstract】 Objective：To investigate the surgical protocol and its clinical outcome of anterior transsternal or anteriorlateral transthoracic approach for upper thoracic vertebral tuberculosis（T1-T4）.Method：A total of 26 patients with upper thoracic tuberculosis from June 2000 to December 2008 were reviewed retrospectively.Of these，16 cases aged from 37 to 72 years old（mean，48.6 years old） underwent one-stage transsternal debridement，decompression，bone graft and instrumentation（group A）.There were 2 patients of Frankel grade A，1 of grade B，2 of grade C，6 of grade D and 5 of grade E.The kyphosis Cobb′s angle ranged from　15° to 40°（mean，22°±3.5°）.Another 10 cases aged from 33 to 69 years old（mean，45.3 years old） experienced debridement，decompression，bone graft and instrumentation by anteriorlateral high transthoracic approach（group B）.There were 1 patient of Frankel grade A，1 of grade B，1 of grade C，4 of grade D and 3 of grade E.The kyphosis Cobb′s angle ranged from　13° to 39°（mean，21°±3.7°）.Result：All patients in two groups experienced surgery successfully.For group A，good field exposure and complete lesion clearance were ensured，the operation time was 120-150min and the intraoperative blood loss was 300-600ml.One patient was complicated with recurrent laryngeal nerve injury and healed two weeks after operation.The kyphosis Cobb′s angle after operation was 10°-25°（mean，17°±2.5°）.All patients in group A were　followed up for 6-72 months，at final follow-up，1 patient of grade A improved to grade D，1 patient of grade B improved to grade C，2 patients of grade C improved to grade D，4 patients of grade D improved to grade E，while no change was noted in other patients.For group B，unsatisfactory contrallateral exposure and lesion clearance occurred，the operation time was 150-220min and the blood loss was 500-900ml.One patient had injury to thoracic duct which healed two weeks postoperatively.Scapular joint malfunction was noted in all patients of group B.The mean Cobb′s angle as for kyphosis correction was 9°-24°（mean，16°±2.3°）.The patients were　followed up for 12-96 months，at final follow-up，1 patient of grade A improved to grade C，1 patient of grade B improved to grade C，1 patient of grade C improved to grade D，4 patients of grade D improved to grade E，while no change was noted in other patients.During the follow-up，all cases healed without any tuberculosis recurrence，and no pull-out and breakage of screws or plates were noted.Spinal union occurred at 3-6 months（mean，4.4 months） postoperatively.Conclusion：Anterior transsternal approach can provide excellent access to the upper thoracic tuberculosis and is less invasive compared with anteriorlateral high transthoracic approach.