Abstract
Direct ventral access to the cervicothoracic spine (C7-T4) poses a technical challenge in spine surgery, given the vital neurovascular structures residing anterior to the cervicothoracic junction (CTJ). The transsternal approach is a feasible surgical option that allows for direct anterior exposure of the lower cervical and upper thoracic vertebrae. Here, the authors report a case of an elderly gentleman with upper thoracic (T1-2) vertebral osteomyelitis and epidural abscess who underwent a transsternal full median sternotomy for ventral decompression and fusion of C7-T2. We also detail our operative procedure and review relevant literature on different transsternal approaches to the CTJ.
Highlights
Obtaining direct ventral access to the cervicothoracic spine (C7-T2) for decompression and fusion is technically challenging, given the anatomical constraints
The anterior transsternal approach is a feasible surgical option that allows for direct exposure of the anterior vertebral elements of the cervicothoracic junction (CTJ)
The authors report a case of an elderly gentleman with upper thoracic vertebral osteomyelitis (T1-2) and epidural abscess who underwent a transsternal full median sternotomy surgical approach for ventral decompression and fusion of C7-T2
Summary
Obtaining direct ventral access to the cervicothoracic spine (C7-T2) for decompression and fusion is technically challenging, given the anatomical constraints. The authors report a case of an elderly gentleman with upper thoracic vertebral osteomyelitis (T1-2) and epidural abscess who underwent a transsternal full median sternotomy surgical approach for ventral decompression and fusion of C7-T2. Preoperative CT imaging showed erosions of the T1 and T2 vertebral bodies with loss of the intervertebral disc space, consistent with discitis and osteomyelitis. Preoperative (A) sagittal and (B) coronal CT imaging showing erosions of the T1 and T2 vertebral bodies, with loss of the intervertebral disc space, consistent with discitis and osteomyelitis. Preoperative MRI showed discitis and osteomyelitis at T1 and T2, anterior epidural collection extending from C7-T2, and severe canal stenosis and cord compression (Figure 2). Preoperative sagittal (A) T1- and (B) T2-weighted MRI showing discitis and osteomyelitis at T1 and T2, anterior epidural collection extending from C7-T2, and severe canal stenosis and cord compression.
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