Artikel
Anterior access to the cervicothoracic junction via partial sternotomy – report on technical feasibility, postoperative morbidity and outcome
Der anteriore Zugang zum zervikothorakalen Übergang über eine partielle Sternotomie – Bericht über die technischen Möglichkeiten, postoperative Morbidität und Outcome
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Veröffentlicht: | 25. Mai 2022 |
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Objective: Surgical access to the anterior structures of the cervicothoracic junction and upper thoracic spine is challenging and controversy persists whether to choose an anterior or posterior approach. The aim of this study was to assess early morbidity and outcome in patients undergoing anterior access to the cervicothoracic junction via partial sternotomy.
Methods: A total of 7 cases, with an acute pathology of the upper thoracic spine from C7 to T4 (3 metastatic fractures, 1 bicycle accident traumatic fracture, 1 tuberculotic fracture, 1 thoracic disc herniation with spinal cord compression, 1 Spondylodiscitis), undergoing ventral thoracic corpectomy and fusion via partial sternotomy between 2017 and 2021 were retrospectively reviewed. Technical feasibility, early and late morbidity and clinical and radiological outcome were evaluated.
Results: Median age was 49 years (range: 21-74 years), 5 (71.4%) were male and 2 (28.6%) female. 5 (71.4%) cases were ASA grade 2, 2 cases (28.6%) were grade 3. The SINS Score was 12 (range 9 – 14). 3 (42.9%) cases underwent additional posterior instrumentation, the other 4 (57.1%) had stand-alone anterior fusion. All surgical procedures were performed uneventfully with no new neurological deficits. Median length of hospital stay was 9 days (range 6-20) including median 1 day on ICU, respectively. Blood transfusion was necessary in three cases. Median blood loss was 500ml. Two cases (33.3%) developed slight to moderate postoperative dysphagia with maintained unrestricted oral diet. Both recovered completely during follow-up. One case developed a wound healing disorder treated conservatively. There was no sternal instability or post-sternotomy pain. All cases were discharged on non-steroidal pain medication only. No in-hospital mortality was observed. Radiological outcome was unremarkable in all cases with no case of implant failure. One case died due to the underlying disease during follow-up. The median follow-up was 3 months (average: 1–29 months).
Conclusion: Our series indicates that the anterior approach to the cervicothoracic junction and upper thoracic spine via partial sternotomy is a safe and effective option to treat anterior spine pathology also in multi-morbid patients. Interdisciplinary approach and stimulation-monitoring contribute to the safety profile and reduce postoperative morbidity. Careful case selection is essential in order to adequately balance clinical benefits and surgical invasiveness for these procedures.