Surgical approach to anterior compression in the upper thoracic spine.
OBJECTIVE
The anterior upper thoracic spine (T1-3) is difficult to access because most neurosurgeons are unfamiliar with the anatomy. This study was performed to evaluate the different surgical options by retrospectively analyzing data on operations performed for anterior upper thoracic compression at the authors' institution.


METHODS
Eighteen patients underwent surgery between November 1993 and May 2001. There were eight men and 10 women; their mean age was 55 years (range 28-80 years). All patients presented with pain and/or neurological deficits. The causes of anterior compression were diverse, although metastatic spinal tumor was most common. The approach chosen was primarily dictated by the axial involvement of the lesion. Anterior approaches, mainly the transmanubrium approach, were performed in six and posterior approaches in 12. In all cases except one, in which only an iliac bone graft was placed, instrumentation was used. The mean follow-up period was 11.4 months (range 1-57 months). One postoperative death occurred. Postoperative follow-up imaging studies, especially plain radiography, demonstrated no instrumentation failure. Improvement was shown in eight patients, an aggravation of symptoms in one, and stable clinical status in eight.


CONCLUSIONS
Decompression may be achieved on the anterior side of the upper thoracic spine if the operative approach is scrupulously chosen; this choice involves consideration of the locations of the lesion, the nature of the primary disease, and the surgery-related risk.
Seol
Ho Jun
HJ
Department of Neurosurgery, Seoul National University College of Medicine, Korea.
Chung
Chun Kee
CK
Kim
Hyun Jib
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011859:Radiography; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome