Extrapleural Approach for Thoracic Vertebral Stabilization

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Surgical access to the upper thoracic vertebral bodies (T1-T5) presents significant technical difficulties.
• The anterior extrapleural approach offers good visualization but is complicated by nearby vital structures like great vessels, sternum, and trachea.

Purpose of the Study:

• To describe a modified anterior extrapleural approach for surgical access to the upper thoracic spine.
• To detail the successful application of this technique in a pediatric patient with a complex spinal injury.

Main Methods:

• A 16-year-old male with avoidant/restrictive food intake disorder and autism spectrum disorder underwent surgery for a traumatic T2 pathological burst fracture.
• The procedure involved thoracic vertebral decompression and stabilization using an anterior extrapleural approach.
• This approach combined a median sternotomy with a lateral cervical incision for enhanced exposure.

Main Results:

• The combined surgical approach provided excellent visualization and access to the anterior upper thoracic vertebral bodies.
• The patient's T2 pathological burst fracture, resulting from spinal hemangioma and osteopenia, was successfully addressed.
• The surgical intervention facilitated necessary decompression and stabilization of the affected thoracic vertebrae.

Conclusions:

• A combined median sternotomy and lateral cervical incision via an anterior extrapleural approach is an effective strategy for accessing the anterior upper thoracic spine.
• This technique overcomes the challenges associated with the anterior extrapleural approach, enabling safe and effective surgical management of complex upper thoracic vertebral pathologies.
• The described approach offers a viable solution for challenging upper thoracic vertebral surgeries, particularly in cases involving trauma and underlying bone conditions.