Anterior Cervicothoracic Junction Corpectomy and Plate Fixation
Anterior Cervicothoracic Junction Corpectomy and Plate Fixation
Object. Exposure of the lower cervical and upper thoracic spinal regions through a cervical incision without sternotomy has been described in cases of anterior decompression and methylmethacrylate vertebral body reconstruction. The use of anterior instrumentation and structural bone grafts in this procedure has not been well described.
Methods. Twenty-one patients underwent anterior cervicothoracic decompression, fusion, and fixation via a low cervical approach. Eight of these patients underwent lower cervical or upper thoracic corpectomy (C7-T4) through the cervical incision. The decompressive procedure was followed by placement of an allograft bone strut and an anterior locking plate system.
No patient developed new neurological deficit related to the spinal cord or exiting nerve roots. Three of four patients with preoperative neurological deficits improved dramatically. Two patients developed recurrent laryngeal nerve palsy, of which one was permanent. There was one case of instrumentation-related failure, and two patients developed a superficial wound infection related to a posterior incision made as part of a 360° fusion. Patients were followed for a mean of 18.5 months (range 2-30 months). Two patients died (of metastatic cancer, and a motor vehicle accident, respectively) during the follow-up period.
Conclusions. Anterior decompression, fusion, and fixation is feasible via a cervical incision. This procedural approach spares the patient the morbidity associated with sternotomy or the lateral extracavitary approach. A thorough preoperative assessment of mediastinal anatomy is essential for the safe execution of these procedures.
Exposure of the anterior aspect of the cervicothoracic junction may be obtained via a low cervical approach with or without the creation of a manubrial window. This approach obviates the need for a thoracotomy or sternotomy and thus avoids their attendant morbidity. Several authors have described the use of such an approach for the decompression of the spinal cord and placement of anterior strut grafts. In particular, the use of methylmethacry-late, with or without supplemental Steinmann pins, has been advocated for the reconstruction of the spine, particularly in patients with cancer. Although some authors have stated that this approach would likely not permit the provision of anterior plate fixation, isolated reports of this procedure exist.
In this series the author describes eight patients in whom anterior cervicothoracic corpectomy and fusion were performed using a low cervical approach, allograft bone, and an anterior cervical plate. The use of such a construct confers some degree of immediate rigidity to the spine and allows for the possibility of bone fusion. Clinical results and several technical caveats are presented.
Object. Exposure of the lower cervical and upper thoracic spinal regions through a cervical incision without sternotomy has been described in cases of anterior decompression and methylmethacrylate vertebral body reconstruction. The use of anterior instrumentation and structural bone grafts in this procedure has not been well described.
Methods. Twenty-one patients underwent anterior cervicothoracic decompression, fusion, and fixation via a low cervical approach. Eight of these patients underwent lower cervical or upper thoracic corpectomy (C7-T4) through the cervical incision. The decompressive procedure was followed by placement of an allograft bone strut and an anterior locking plate system.
No patient developed new neurological deficit related to the spinal cord or exiting nerve roots. Three of four patients with preoperative neurological deficits improved dramatically. Two patients developed recurrent laryngeal nerve palsy, of which one was permanent. There was one case of instrumentation-related failure, and two patients developed a superficial wound infection related to a posterior incision made as part of a 360° fusion. Patients were followed for a mean of 18.5 months (range 2-30 months). Two patients died (of metastatic cancer, and a motor vehicle accident, respectively) during the follow-up period.
Conclusions. Anterior decompression, fusion, and fixation is feasible via a cervical incision. This procedural approach spares the patient the morbidity associated with sternotomy or the lateral extracavitary approach. A thorough preoperative assessment of mediastinal anatomy is essential for the safe execution of these procedures.
Exposure of the anterior aspect of the cervicothoracic junction may be obtained via a low cervical approach with or without the creation of a manubrial window. This approach obviates the need for a thoracotomy or sternotomy and thus avoids their attendant morbidity. Several authors have described the use of such an approach for the decompression of the spinal cord and placement of anterior strut grafts. In particular, the use of methylmethacry-late, with or without supplemental Steinmann pins, has been advocated for the reconstruction of the spine, particularly in patients with cancer. Although some authors have stated that this approach would likely not permit the provision of anterior plate fixation, isolated reports of this procedure exist.
In this series the author describes eight patients in whom anterior cervicothoracic corpectomy and fusion were performed using a low cervical approach, allograft bone, and an anterior cervical plate. The use of such a construct confers some degree of immediate rigidity to the spine and allows for the possibility of bone fusion. Clinical results and several technical caveats are presented.
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