Anterior transsternal approach for treatment of upper thoracic vertebral tuberculosis.
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.


CONCLUSIONS
The anterior transsternal approach provides safe and effective access for surgical treatment of upper thoracic TB.
Department of Spinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Hua
H
Jiang
Zeng-Ming
ZM
Xiao
Xin-Li
XL
Zhan
Mao-Lin
ML
He
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000379:methods*; D056346:Sternotomy; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000601:surgery*