Anterior transsternal approach for treatment of upper thoracic vertebral tuberculosis

Abstract

Objective: To study an anterior transsternal approach for treatment of upper thoracic vertebral (T(l)-T(4)) tuberculosis (TB).

Methods: Sixteen patients with upper thoracic vertebral TB underwent anterior decompression and fusion through an anterior transsternal approach. There were nine men and seven women with a mean age of 48.6 ± 2.3 years (range, 37 to 72 years). The involved area included T(l) in three patients, T(2) in one, T(2) and T(3) in four, T(3) in two, T(3) and T(4) in four, and T(4) in two. The "inside window of the brachiocephalic artery" was used to access T(1) and T(2) lesions, and the "outside window of the brachiocephalic artery" for T(3) and T(4) lesions, for T2 and T3, both "windows" were used. According to the Frankel grading system, two patients were of Grade A, one Grade B, two Grade C, six Grade D and five Grade E. The kyphosis Cobb's angle ranged from 15°-40° (mean, 22° ± 2.5°) preoperatively.

Results: All patients tolerated surgery wel1. The operation time was 120-150 minutes and bleeding during operation 300-600 ml. The kyphosis Cobb's angle ranged from 10°-25° (mean, 17° ± 2.5°) postoperatively. Eight patients with preoperative neurologic deficit had improved. During the follow-up period, all cases healed without any recurrence. There was no failure of internal fixation. Spinal bone fusion occurred after 3-6 months (mean, 4.2 months) after bone graft in all patients.

Conclusion: The anterior transsternal approach provides safe and effective access for surgical treatment of upper thoracic TB.

Figure 1

The skin incision is made firstly along the inferior third of the anteriomedial part of the right sternocleidomastoid to the mid point of the suprasternal notch, then longitudinally along the midsternal line to a point 5 cm below to sternal angle.

Figure 2

Limited sternotomy. The manubrium sterni is spilt longitudinally at the midline, then the sternum is spilt transversely at the level of the third right rib by a sternal saw.

Figure 3

A 64‐year old woman with T₃ and T₄ TB achieved good recovery after operation by the anterior transsternal approach. (a) Preoperative CT scan shows the tuberculous focus is at T₃ and T₄. (b) Preoperative MRI shows that the spinal cord is compressed in the corresponding segment. (c) Postoperative CT scan showing that the tuberculous focus has been completely removed and spinal stability reconstructed. (d) Postoperative MRI showing that the spinal cord has been decompressed effectively.