Abstract
BackgroundIn total en bloc spondylectomy (TES) of upper thoracic spine including the second thoracic (T2) vertebra, T2 nerve roots are usually transected. In this study, we examined the association between transection of the T2 nerve roots and upper-extremity motor function in patients with upper thoracic TES.MethodsWe assessed 16 patients who underwent upper thoracic TES with bilateral transection of the T2 nerve roots. Patients were divided into three groups: 3 patients without any processing of T1 and upper nerve roots (T2 group), 7 with extensive dissection of T1 nerve roots (T1–2 group), and 6 with extensive dissection of T1 and upper nerve roots (C–T2 group). Postoperative upper-extremity motor function was compared between the groups.ResultsPostoperative deterioration of upper-extremity motor function was observed in 9 of the 16 patients (56.3%). Three of the 7 patients in the T1–2 group and all 6 patients in the C–T2 group showed deterioration of upper-extremity motor function, but there was no deterioration in the T2 group. In the T1–2 group, 3 patients showed mild deterioration that did not affect their activities of daily living and they achieved complete recovery at the latest follow-up examination. In contrast, severe dysfunction occurred frequently in the C–T2 group, without recovery at the latest follow-up.ConclusionsThe transection of the T2 nerve roots alone did not result in upper-extremity motor dysfunction; rather, the dysfunction is caused by the extensive dissection of the T1 and upper nerve roots. Therefore, transection of the T2 nerve roots in upper thoracic TES seems to be an acceptable procedure with satisfactory outcomes.
Highlights
Total en bloc spondylectomy (TES) is a surgical procedure designed to achieve complete resection of spinal tumors, including primary malignant, aggressive benign, and metastatic tumors [1,2]
In our surgical method for upper thoracic total en bloc spondylectomy (TES), in order to prevent upper-extremity motor dysfunction, the T1 and upper nerve roots are preserved by extensive circumferential dissection to the extraforamen, and the T2 and lower nerve roots are sacrificed by transection (Figure 1)
Evaluation Item Patients were divided into three groups: 3 patients without any processing of T1 and upper nerve roots (T2 group), 7 with extensive dissection of T1 nerve roots (T1–2 group), and 6 with extensive dissection of T1 and upper nerve roots (C–T2 group)
Summary
Total en bloc spondylectomy (TES) is a surgical procedure designed to achieve complete resection of spinal tumors, including primary malignant, aggressive benign, and metastatic tumors [1,2]. In TES, en bloc resection of the posterior element (en bloc laminectomy) and en bloc resection of the anterior element (en bloc corpectomy) were performed to obtain an adequate tumor margin, with extensive dissection and/or transection of spinal nerve roots. In our surgical method for upper thoracic TES, in order to prevent upper-extremity motor dysfunction, the T1 and upper nerve roots are preserved by extensive circumferential dissection to the extraforamen, and the T2 and lower nerve roots are sacrificed by transection (Figure 1). In total en bloc spondylectomy (TES) of upper thoracic spine including the second thoracic (T2) vertebra, T2 nerve roots are usually transected. We examined the association between transection of the T2 nerve roots and upper-extremity motor function in patients with upper thoracic TES
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