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Baker JF. Analysis of Sagittal Thoracic Inlet Measures in Relation to Anterior Access to the Cervicothoracic Junction. Global Spine J 2023; 13:705-712. [PMID: 34018449 DOI: 10.1177/21925682211005730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective radiographic study. OBJECTIVE The aim of this study was to define the association between thoracic inlet measures in relation to anterior access to the cervicothoracic junction. METHODS Trauma CT scans in patients >16 years were analyzed. The projection angle (PA), defined as the angle subtended by a line along the superior endplate of the vertebral body and the line from the anterosuperior corner of the vertebral body to the manubrium, was measured at C7, T1 and T2; angles were positive if the projection was above the manubrium. Thoracic inlet angle (TIA), thoracic inlet distance (TID) and pelvic incidence (PI) were measured. RESULTS 65 scans were assessed (33 males; mean age 47.7 years (s.d. 8.7)). The mean TIA 79.9° (s.d. 13.4°; range 52.6° - 112.2°), mean TID 66.1 mm (s.d. 6.6 mm) and mean PI was 50.5° (s.d. 10.2°). Mean values for the projection angles at C7, T1 and T2 were 24.2°, 7.6° and -8.3° respectively. PA were positive in 95% at C7, 73% at T1 and 30% at T2. PA at each level correlated significantly with age (mean r=-0.371; P = .015) and TIA (mean r=-0.916; P < .001) but neither TID nor PI. TIA correlated with age (r = 0.328; P = .008). CONCLUSIONS The projection angles of the CTJ vertebrae are influenced by thoracic inlet angle and a lesser degree age. Understanding sagittal spinal parameters in the CTJ can aid in planning surgical strategy and approach.
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Affiliation(s)
- Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Analysis of the Curative Effect of the Anterior Approach to the Lower Cervical Spine for Cervicothoracic Spinal Tuberculosis. J Craniofac Surg 2020; 31:480-483. [PMID: 31895841 DOI: 10.1097/scs.0000000000006097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this study was to explore the clinical effect of the anterior approach to the lower cervical spine for cervicothoracic spinal tuberculosis (CTSTB). METHODS A total of 8 patients (6 males and 2 females) with CTSTB diagnosed by imaging examination and γ-interferon test, underwent the first stage lesion removal, bone grafting and internal fixation through the anterior approach to the lower cervical spine, were studied. Then, the clinical efficacy was evaluated using statistical analysis based on the materials about the Cobb angle of kyphosis, visual analog scale (VAS), Frankel grade, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). RESULTS All patients' age ranged from 28 to 64 years (mean 46.2 ± 16.3). The mean operation time was 145 minutes (range 90-180 mins), intraoperative blood loss was 425 mL (range 200-1000 mL), and the average bone fusion time was 7.4 months. Postoperative neurological function of Frankel grading was significantly improved compared with that of preoperative. At final follow-up, the kyphosis angle was significantly decreased to 10 ± 2.1°, the mean VAS score was 1.6 ± 0.9 showing significant improvement, ESR and CRP returned to normal. The incidence of complications within 3 months after surgery was 25%, and the incidence of complications directly related to surgery was 12.5% (cerebrospinal fluid leakage). CONCLUSION On the basis of familiarity with the anatomical structure and combining with the experience of the surgeon, the anterior approach to the lower cervical spine can be an effective treatment method for CTSTB.
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Wu WJ, Tang Y, Lyu JT, Yang S, Wang DG, Zhang Q, Liu X, Deng JZ, Luo F, Hou TY, Xu JZ, Zhang ZH. Clinical Efficacy of Three Surgical Approaches for the Treatment of Cervicothoracic Tuberculosis: A Multicenter Retrospective Study. Orthop Surg 2019; 12:1579-1588. [PMID: 31568641 PMCID: PMC7767672 DOI: 10.1111/os.12527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the efficacy of three surgical approaches for the treatment of cervicothoracic tuberculosis. Methods This is a multicenter retrospective study. We analyzed 74 patients with cervicothoracic tuberculosis who were treated in six institutions between January 2000 and January 2015. There were 37 male and 37 female patients, with an average age of 24 years (range, 5–62 years). The operative method was selected according to the indications. A total of 33 patients underwent one‐stage anterior surgery (group A); 16 underwent a combined anterior and posterior surgery (group B) and 25 underwent one‐stage posterior surgery (group C). Clinical outcomes, laboratory indexes, and radiological results were analyzed. Results All cases were followed up for approximately 36–96 months post‐surgery (average, 39 months). At the last follow‐up, patients in all three groups had achieved bone fusion, with pain relief and neurological recovery. No major vessel and nerve injuries were found during the operation. There were significant differences before and after treatment for visual analogue scale (VAS), neck disability index (NDI), and Japanese Orthopedic Association (JOA) score (P < 0.001). Three surgical strategies significantly improved kyphosis (P < 0.001). Conclusion The choice of operation for cervicothoracic tuberculosis should be selected based on the pathological changes, scope, and general physical condition of the patient. The indication for a posterior approach is narrow and it should be used selectively. The combined anterior and posterior approach involved a longer operating time, larger blood loss, and greater trauma, and also required a higher level of surgical skill. Therefore, the indications for this approach should be strictly controlled. Anterior approach surgery for the treatment of cervicothoracic tuberculosis showed excellent efficacy and fewer complications.
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Affiliation(s)
- Wen-Jie Wu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yong Tang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jing-Tong Lyu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Sen Yang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Dong-Gui Wang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Qiang Zhang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xun Liu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jie-Zhong Deng
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Tian-Yong Hou
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jian-Zhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ze-Hua Zhang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
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Zhu Z, Hao D, Wang B, Gao W, Yang R, Guo H, Wang Y, Kong L. Selection of surgical treatment approaches for cervicothoracic spinal tuberculosis: A 10-year case review. PLoS One 2018; 13:e0192581. [PMID: 29420648 PMCID: PMC5805302 DOI: 10.1371/journal.pone.0192581] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/26/2018] [Indexed: 11/25/2022] Open
Abstract
Background Cervicothoracic spinal tuberculosis is a rare disease. Due to its difficult and challenging surgical exposure, its surgical treatment approach remains inconclusive. Long-term follow-up studies to address this puzzling issue are rarely seen in the literature. The purpose of this study was to explore the selection of surgical treatment approaches for cervicothoracic spinal tuberculosis through a 10-year case review. Methods From January 2003 to January 2013, 45 patients suffering from cervicothoracic spinal tuberculosis were treated surgically. According to the relation between the tuberculosis lesion segments and the suprasternal notch on sagittal MRI, 19 patients were treated with a single-stage anterior debridement, fusion and instrumentation approach, and the other 26 patients were treated with a single-stage anterior debridement and fusion, posterior fusion and instrumentation approach. The clinical efficacy was evaluated using statistical analysis based on the Cobb angle of kyphosis, the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) scoring system. The neurofunctional recovery was assessed by the American Spinal Injury Association (ASIA) system. Results All patients were followed up for 6.6 years on average (range 3–13 years). No instrumentation loosening, migration or breakage was observed during the follow-up. The kyphosis angle and NDI and JOA scores were significantly changed from preoperative values of 34.7±6.8°, 39.6±4.6 and 10.7±2.8 to postoperative values of 10.2±2.4°, 11.4±3.6 and 17.6±2.4, respectively (p<0.05). Aside from one recurrent patient, bone fusion was achieved in the other 44 patients within 6 to 9 months (mean 7.2 months). No severe postoperative complications occurred, and patients’ neurologic function was improved in various degrees. Conclusions In the surgical treatment of cervicothoracic spinal tuberculosis, single-stage cervical anterior approach with or without partial manubriotomy is capable of complete debridement for tuberculosis lesions. The manner of fixation should be selected based on the anatomical relation of the suprasternal notch and the diseased segments as revealed on sagittal MRI images.
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Affiliation(s)
- Ziqi Zhu
- Xi’an Medical University, Beilin District, Xi’an, Shaanxi, China
- Department of Spine Surgery, Honghui Hospital Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, China
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, China
- * E-mail: (BW); (LK)
| | - Wenjie Gao
- Department of Spine Surgery, Honghui Hospital Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, China
| | - Ruize Yang
- Department of Spine Surgery, Honghui Hospital Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, China
| | - Hua Guo
- Department of Spine Surgery, Honghui Hospital Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, China
| | - Yongyi Wang
- Department of Spine Surgery, Honghui Hospital Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, China
| | - Lingbo Kong
- Department of Spine Surgery, Honghui Hospital Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, China
- * E-mail: (BW); (LK)
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Posterior Vertebral Column Resection With Intraoperative Manual Retraction for the Treatment of Posttubercular Kyphosis in Upper Thoracic Spine or Cervicothoracic Junction. Clin Spine Surg 2017; 30:E1055-E1061. [PMID: 27906739 DOI: 10.1097/bsd.0000000000000479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a case-series. OBJECTIVE To evaluate the clinical and radiologic outcomes of posterior vertebral column resection (PVCR) for treatment of posttubercular kyphosis in upper thoracic spine and cervicothoracic junction (CTJ). SUMMARY OF BACKGROUND DATA Surgical management of severe posttubercular kyphosis in upper thoracic spine or CTJ is challenging. A new technique that combines PVCR and intraoperative manual traction in a single procedure, was developed to maximize the correction rate and minimize the risk of dural buckling and spinal cord injury. However, the safety and effectiveness of the procedure is yet to be established. MATERIALS AND METHODS Ten patients with upper thoracic or CTJ posttubercular kyphosis, who underwent PVCR with intraoperative manual traction between December 2008 and 2013, were studied retrospectively. Data pertaining to operation time, blood loss, and perioperative complications were collected. Outcomes were evaluated using the visual analog scale; the 12-Item Short Form Health Survey (SF-12), Mental Component Summary, and SF-12 Physical Component Summary. Neurological status was assessed using American Spinal Injury Association (ASIA) impairment scale. Radiologic outcomes including fusion and deformity correction were assessed using plain radiography and computed tomography. RESULTS The average duration of follow-up was 53.6±7.2 months. Average operating time and blood loss were 263±35.3 minutes and 2490±569 mL, respectively. Visual analog scale score for back pain, SF-12 Mental Component Summary, and Physical Component Summary showed significant improvement postoperatively. Kyphosis improved from a preoperative average of 73.6±13.1 degrees to an average of 37.9±8.7 degrees at final follow-up (correction rate: 48.5%). No postoperative neurological deterioration was observed based on the ASIA score. As of the last follow-up, solid fusion was not achieved only in 1 patient. CONCLUSIONS PVCR with intraoperative manual traction is a safe and effective procedure for treatment of upper thoracic or CTJ posttubercular kyphosis. LEVEL OF EVIDENCE Level 4.
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Neumayr A, Tamarozzi F, Goblirsch S, Blum J, Brunetti E. Spinal cystic echinococcosis--a systematic analysis and review of the literature: part 2. Treatment, follow-up and outcome. PLoS Negl Trop Dis 2013; 7:e2458. [PMID: 24069501 PMCID: PMC3777903 DOI: 10.1371/journal.pntd.0002458] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/13/2013] [Indexed: 12/13/2022] Open
Abstract
Bone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in approximately 50% of cases. Despite significant advances in diagnostic imaging techniques, surgical treatment and introduction of pharmacological therapy, spinal echinococcosis remains associated with a high degree of morbidity, disability and mortality. We systematically reviewed the published literature of the last five decades to update and summarize the currently existing data on treatment, follow-up and outcome of spinal CE.
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Affiliation(s)
- Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Francesca Tamarozzi
- Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S. Matteo Hospital Foundation, WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Sam Goblirsch
- Department of Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Enrico Brunetti
- Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S. Matteo Hospital Foundation, WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
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A large tuberculosis abscess causing spinal cord compression of the cervico-thoracic region in a young child. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1459-63. [PMID: 23604937 DOI: 10.1007/s00586-013-2729-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 02/18/2013] [Accepted: 02/20/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Despite numerous descriptive publications, the guidelines for treatment of cervical spinal tuberculosis (TB) are not very clear. The authors report a case of a young girl with cervico-thoracic spinal TB extending from C5 to T3 vertebrae presenting with weakness of the right hand and unsteady gait. CASE REPORT An 11-year-old female who is an immigrant to the UK from Afghanistan, presented to our clinic with a 10-day history of difficulty in walking with an unsteady gait and 3-month history of progressive weakness in both her arms, the right side more affected than the left. Her immunisation history was unclear. Examination of the arms showed bilateral thenar and hypothenar wasting, more so on the right than the left. An MRI scan revealed a large para-spinal abscess extending from C3/4 to T4/5 with a significant anterior epidural cord compression from C5/6 to T2/3. Therapeutic/diagnostic aspiration was performed under ultrasound guidance and the aspirate was sent for microbiology. She was started empirically on multidrug anti-tubercular treatment and steroids. Although Ziehl-Neelsen stain was negative for acid-fast bacilli, microbiological confirmation of TB was obtained by positive TB culture sensitive to all first-line anti-TB drugs. She made a dramatic improvement within 3 weeks of anti-tubercular treatment. A follow-up MRI scan at 8 months showed complete resolution of the abscess. At 2 years of follow-up, she was a healthy looking child, back to her school with no residual clinical signs/symptoms of the disease. CONCLUSION Our case of cervico-thoracic tuberculous abscess in a young child suggests that even with incomplete neurological deficit caused by epidural cord compression, ultrasound (or CT)-guided aspiration and anti-tubercular medication provide acceptable results at 2 years of follow-up.
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Debridement and bone grafting with internal fixation via anterior approach for treatment of cervicothoracic tuberculosis. Int Surg 2012; 96:358-62. [PMID: 22808620 DOI: 10.9738/cc62.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to investigate the outcome of the patients with cervicothoracic tuberculosis who underwent radical debridement, reconstruction with bone autograft or allograft, and plate internal fixation via anterior approach. From June 2000 to December 2010, 20 patients with tuberculosis in cervicothoracic junction underwent a standard cervical approach, which was combined with a partial median osteotomy and transverse osteotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Radical debridement was performed, then tricortical iliac crest bone autograft or allograft was placed and internal fixation was done to reconstruct the spinal column. The pathologic change regions were as follows: 10 in the C7-T1 segment, 6 in the T1 segment, 3 in the T1-T3 segment, and 1 in the T2-T3 segment. The classifications of Frankel were as follows: 2 at grade A, 4 at grade B, 7 at grade C, 2 at grade D, and 5 at grade E. There was no injury of blood vessel, spinal cord, or recurrent nerve during the surgery. The follow-up period ranged approximately 16 to 39 months. Bony fusion was obtained in all patients, and there was no internal fixation failure and tuberculosis recurrence in any of these patients. The nerve function of the spinal cord recovered at different degrees: 2 at grade A, 1 at grade B, 1 at grade C, 3 at grade D, and 13 at grade E. The anterior approach can provide direct and safe access to the lesion. The structural iliac crest autograft or allograft and anterior instrumentation could work effectively to stabilize the cervicothoracic junction.
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One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of cervicothoracic spinal tuberculosis with kyphosis in children: a preliminary report. Childs Nerv Syst 2011; 27:735-42. [PMID: 21057955 DOI: 10.1007/s00381-010-1319-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the efficacy and feasibility of surgical management of cervicothoracic tuberculosis accompanied by kyphosis in children by using one-stage posterior focus debridement, bone graft fusion, and instrumentation at a single institution. METHODS Ten consecutive cases with cervicothoracic tuberculosis with kyphosis were treated with one-stage posterior focus debridement, bone graft fusion, and instrumentation. The mean follow-up was 36 months (range 26-47 months). The kyphotic angle ranged from 35° to 62° before operation, 50.5° in average. The American Spinal Injury Association score system was used to evaluate the neurological deficits. RESULTS Spinal tuberculosis was completely cured in all ten patients. There was no recurrent tuberculous infection. The postoperative kyphotic angle was 10° to 22°, 17.5° in average, and there was no significant loss of the correction at the latest follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. CONCLUSIONS One-stage posterior debridement, bone grafting, and instrumentation can be an effective treatment method of cervicothoracic spinal tuberculosis with kyphosis in children.
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Keachie K, Shahlaie K, Muizelaar JP. Upper thoracic spine arthroplasty via the anterior approach. J Neurosurg Spine 2010; 13:240-5. [PMID: 20672961 DOI: 10.3171/2010.3.spine09654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Significant progress has been made in lumbar and cervical disc replacement therapy. Several cervical disc prostheses have recently gained FDA approval. Although arthroplasty has not been previously described in the thoracic spine, selected patients with long-segment fusion to the level of C-7 have altered cervicothoracic and upper thoracic biomechanics and may benefit from motion-preservation therapy for T1-2 disc herniation. Currently, FDA-approved prostheses are indicated only for patients with single-level degenerative disc disease between C-3 and C-7 and no history of cervical arthrodesis. The authors describe a 52-year-old woman who had previously undergone C3-7 fusion and returned 4 years later with symptoms of C-8 myeloradiculopathy and radiological evidence of T1-2 degenerative disc disease. She underwent T1-2 arthroplasty in which a Prestige artificial cervical disc was placed via an anterior cervicothoracic approach. Motion at C7-T1 and T1-2 was preserved, and the patient made an excellent clinical recovery.
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Affiliation(s)
- Krista Keachie
- Department of Neurological Surgery, University of California, Davis, Sacramento, California 95817, USA
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Huang YX, Ni WF, Wang S, Xu H, Wang XY, Xu HZ, Chi YL, He JW. Anterior approaches to the cervicothoracic junction: a study on the surgical accessibility of three different corridors based on the CT images. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:1936-41. [PMID: 20549258 DOI: 10.1007/s00586-010-1478-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 05/23/2010] [Accepted: 06/03/2010] [Indexed: 11/30/2022]
Abstract
To determine the location of left brachiocephalic vein (BCV) and tracheal bifurcation (TB) relative to the vertebral levels, and to ascertain the accessibility of three different corridors (C1: between the esophagus and trachea medially and the carotid sheath laterally, C2: between the right BCV and the brachiocephalic artery, and C3: between the ascending aorta and superior vena cava) for preoperative planning. From August 2008 to April 2009, normal chest CT scans of 150 subjects ranging in age from 18 to 78 years were selected. According to our definition, of the 150 studies, 132 T2 vertebral bodies (VBs) could be accessed through C1 (88.0%), 100 T3 VBs could be reached through C2 (66.7%), and 110 T4 VBs could be exposed through C3 (73.3%). The results suggest that the surgical accessibility of three different corridors is different and we conclude that T2, T3, and T4 are, respectively, readily accessible through C1, C2, and C3.
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Affiliation(s)
- Yi-Xing Huang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuan Road, Wenzhou, China
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[Cervicomanubrial route for the ventral upper thoracic spine: technical note about six cases]. Neurochirurgie 2008; 54:105-12. [PMID: 18343460 DOI: 10.1016/j.neuchi.2007.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 11/15/2007] [Indexed: 11/22/2022]
Abstract
Ventrolateral cervicotomy provides a narrowed working space for surgical management of upper thoracic spine. We report our experience about ventral upper thoracic spinal cord decompression with reconstruction and plating via the cervicomanubrial route. Six patients (24 to 75 years old) were operated on by the same operator (LN) by cervicomanubriotomy from 2002 to 2007 for upper thoracic spinal cord compression (one case of Pott's disease, three cases of metastases, one fracture, one invasive hemangio-epithelioma), with a good outcome in five patients. Lesions were located from the cervicothoracic junction down to the fourth thoracic vertebra (T4). In all cases, anterior spinal cord decompression, strut graft reconstruction (iliac bone in two cases, cement in four cases) and osteosynthesis were performed. In two cases, a second stage posterior decompression with fixation was performed. The approach begins by a left sided anterior cervicotomy, medial to the sternocleidomastoid muscle and lateral to the trachea and esophagus, associated with division of the infrahyoid muscles close to their insertion at the upper thoracic outlet followed by osteotomy of the manubrium sterni. Then, division of the thyropericardic fascia and thymus, control of the brachiocephalic vein, control of the thoracic lymphatic duct and the horizontal thoracic aorta are performed. The ventral part of fifth cervical vertebra body down to T4 is then exposed between the left primitive carotid artery laterally, the esophagus medially and the thoracic aorta caudally. Compared to total sternotomy without or with clavicle resection, cervicomanubriotomy seems to be a less aggressive, safe and reliable procedure.
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