Mini Thoracotomy Approach to Upper Thoracic Spine

Abstract

Upper thoracic spine lesions are characterized by delayed diagnosis due to nonspecific symptoms and its anterior aspect (T1 - T4) is difficult to be approached surgically. This retrospective clinical study was done to assess the efficacy of mini thoracotomy approach in management of these lesions. We studied 14 cases with upper thoracic spine different pathological lesions at levels (T1 - T4). These lesions were indicated for anterior approach surgery. Radiological assessment included plain X-ray, MRI and CT scan thoracic spine. The anaesthesia was specifically selective intubation and unilateral ventilation. All patients were operated upon through mini inter-costal thoracotomy approach (left sided in 13 patients and right sided in 1patient). Out of 14 patients there were 7 males and 7 females. The age range was 20 - 55 years (mean 38.7 years). Preoperative symptoms included vague nonspecific upper thoracic pain in 11 patients, lower limbs weakness in 6 patients, sphincteric disturbance in 5 patients, upper thoracic kyphotic deformity in 4 patients, severe brachialgia in 3 patients and neck pain in 2 cases. The operative time was ranged from 90 - 210 minutes (mean 152 m). Blood loss ranged from 250 to 750 cc (mean 464 cc). Chest tube drainage was inserted in all patients. There were no intra-operative or post-operative surgically related complications and no patients needed ICU admission. The lesions were neoplasms in 8 patients, traumatic fracture dislocation in 3 cases, tuberculous spondylodiscitis in 2 cases and degenerative disc prolapse in 1 case. All patients improved post-operative as regard their pre-operative complaints except one patient. During the follow up period, no mortality was recorded. In conclusion, mini thoracotomy approach seems to be ideal only for patients with mono- or bi-segmental pathology involving the upper thoracic spine.