Surgical treatment of upper thoracic spine metastatic tumor via anterior approach

English Keywords:Metastatic tumor  Anterior  Upper thoracic vertebrae  Internal fixation

English Abstract:

  【Abstract】 Objectives: To discuss the techniques and outcomes of anterior approach for metastasis resection and reconstruction with titanium plate for upper thoracic vertebral tumor. Methods: From June 2004 to July 2011, there were 6 males and 11 females with the average age of 55.1±7.3 years(range, 47-68 years) with the upper thoracic(T1-T4) metastatic tumor underwent anterior resection and fixation. Their neurological function was assessed by Frankel classification as following, 3 cases with grade B, 4 cases with grade C, 8 cases with grade D and 2 cases with grade E. The tumors located at T1 in 7 cases, T2 in 5 cases, T3 in 3 cases, T4 in 2 cases. Tokuhashi scoring system of 17 cases ranged from 9 to 12 points. The tumors located in the vertebral body of sectors 4-9 based on the WBB staging system. For T1 lesion, low anterior cervical approach was used, and for T2-T4 lesion, anterior transsternal approach of outside window of brachiocephalic artery was used. Results: All patients survived the surgery, the operation time of anterior cervical approach was 90-102min(average: 94.1±5.0min), blood loss was 100-400ml(average: 186.6±100.2ml); the operation time of anterior transsternal approach outside window of brachiocephalic artery was 100-150min(average: 121.0±16.5min), blood loss was 220-600ml(average: 352.0±134.4ml). Pathological examination revealed metastatic lung cancer in 6 patients, metastatic breast cancer in 5 patients, metastatic thyroid carcinoma in 2 patients， metastatic gastrointestinal cancer in 2 patients and uncertainly metastatic tumor in 2 patients. Pneumonia and atelectasis occurred in 2 patients and recovered well after proper treatment; 3 patients appeared transient hoarseness and returned to normal 1 month later. The mean follow-up was 19.7±9.8 months(range, 6 to 48 months). Neurological function improved in 9 cases, 2 patients improved from grade B to E, 1 patient improved from grade B to grade D; 2 patients in grade C improved to grade E, 2 patients in grade C improved to grade D and 2 patients in grade D improved to grade E. 5 patients died of systemic failure due to multiple metastases at 6-14 months. Conclusions: The anterior approach is reliable for thoracic spinal metastasis, which is superior for sufficient exposure and removal of vertebral defects．