Derek T Bernstein1, Wu Zhuge2, Shanda H Blackmon3, Rex A W Marco4,5. 1. Department of Orthopaedic Surgery, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower, Suite 2500, Houston, TX, 77030, USA. 2. Department of Orthopaedic Surgery, Univeristy of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA. 3. Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower, Suite 1601, Houston, TX, 77030, USA. 4. Department of Orthopaedic Surgery, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower, Suite 2500, Houston, TX, 77030, USA. rexmarco@gmail.com. 5. Department of Orthopaedic Surgery, Univeristy of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA. rexmarco@gmail.com.
Abstract
PURPOSE: High thoracotomy allows access to the anterior cervicothoracic and upper thoracic vertebrae; however, traditional techniques transect shoulder girdle muscles, leading to postoperative shoulder dysfunction. Muscle-sparing techniques diminish this concern, but often sacrifice the quality of exposure. We describe a novel muscle-sparing, high thoracotomy approach for the treatment of ventral cervicothoracic and upper thoracic spine lesions. METHODS: A novel muscle-sparing, high thoracotomy approach is described, utilizing a midline posterior incision with lateral extension from the lateral decubitus position. Five patients are presented to illustrate the application of this technique in thoracic tumors with intimate spinal involvement. RESULTS: The muscle-sparing, high thoracotomy approach afforded gross total resection and spinal reconstruction in five consecutive patients, including stage IV lung carcinoma with invasion of the T5 and T6 vertebral bodies, two malignant fibrous histiocytomas causing thoracic cord compression, a metastatic T6 lesion of unknown primary with associated cord compression; and a Pancoast tumor. All patients seen at 6 months had full symmetric shoulder range of motion postoperatively. CONCLUSIONS: The described muscle-sparing, high thoracotomy approach provides excellent exposure of the ventral cervicothoracic and upper thoracic spine without the morbidity associated with the transection of shoulder girdle muscle bellies. This technique is particularly useful in patients with primary malignant bone tumors requiring en bloc excision and metastatic tumors with large soft tissue components.
PURPOSE: High thoracotomy allows access to the anterior cervicothoracic and upper thoracic vertebrae; however, traditional techniques transect shoulder girdle muscles, leading to postoperative shoulder dysfunction. Muscle-sparing techniques diminish this concern, but often sacrifice the quality of exposure. We describe a novel muscle-sparing, high thoracotomy approach for the treatment of ventral cervicothoracic and upper thoracic spine lesions. METHODS: A novel muscle-sparing, high thoracotomy approach is described, utilizing a midline posterior incision with lateral extension from the lateral decubitus position. Five patients are presented to illustrate the application of this technique in thoracic tumors with intimate spinal involvement. RESULTS: The muscle-sparing, high thoracotomy approach afforded gross total resection and spinal reconstruction in five consecutive patients, including stage IV lung carcinoma with invasion of the T5 and T6 vertebral bodies, two malignant fibrous histiocytomas causing thoracic cord compression, a metastatic T6 lesion of unknown primary with associated cord compression; and a Pancoast tumor. All patients seen at 6 months had full symmetric shoulder range of motion postoperatively. CONCLUSIONS: The described muscle-sparing, high thoracotomy approach provides excellent exposure of the ventral cervicothoracic and upper thoracic spine without the morbidity associated with the transection of shoulder girdle muscle bellies. This technique is particularly useful in patients with primary malignant bone tumors requiring en bloc excision and metastatic tumors with large soft tissue components.
Authors: F Benedetti; S Vighetti; C Ricco; M Amanzio; L Bergamasco; C Casadio; R Cianci; R Giobbe; A Oliaro; B Bergamasco; G Maggi Journal: J Thorac Cardiovasc Surg Date: 1998-04 Impact factor: 5.209
Authors: S Gandhi; G L Walsh; R Komaki; Z L Gokaslan; J C Nesbitt; J B Putnam; J A Roth; K W Merriman; I E McCutcheon; R F Munden; S G Swisher Journal: Ann Thorac Surg Date: 1999-11 Impact factor: 4.330
Authors: F Benedetti; M Amanzio; C Casadio; P L Filosso; M Molinatti; A Oliaro; F Pischedda; G Maggi Journal: Ann Thorac Surg Date: 1997-07 Impact factor: 4.330
Authors: G L Walsh; Z L Gokaslan; I E McCutcheon; M T Mineo; A W Yasko; S G Swisher; D S Schrump; J C Nesbitt; J B Putnam; J A Roth Journal: Ann Thorac Surg Date: 1997-12 Impact factor: 4.330