Department of Medico-Surgical Sciences and Biotechnologies, University of Rome La Sapienza, Polo Pontino, Latina, Italy.
J Neurosurg Spine. 2012 Jan;16(1):22-6. doi: 10.3171/2011.9.SPINE10834. Epub 2011 Oct 7.
The authors' aim was to conduct a surgical anatomy and feasibility study on the use of an extended posterolateral approach to the cervicothoracic junction (Fessler approach) in cadavers to facilitate en bloc removal of the second thoracic vertebra using the Tomita technique. To apply this technique, it is mandatory to approach both sides of the vertebra. But such a maneuver is very difficult in the region of the cervicothoracic junction because the scapula and its muscles represent an anatomical barrier to the paravertebral compartment and lateral aspects of the vertebrae.
To study the extended posterolateral Fessler approach to the cervicothoracic junction and the possible application of the Tomita technique on the second thoracic vertebra, 3 fresh-frozen cadavers were used in the Laboratory of Human Anatomy at the University of Nantes.
The proposed approach allows exposure of both the posterior arch and the body of the second thoracic vertebra without any significant resection or traction of the superficial and deep posterior thoracic muscles, enabling application of the Tomita technique and facilitating intraoperative spinal fixation.
The proposed surgical technique is technically feasible. Nevertheless, it should be an option reserved for selected patients for whom the surgical complexity can be justified by the characteristics of their malignancy and expected curative outcome.
作者旨在对尸体进行颈椎胸椎交界区扩大后外侧入路（Fessler 入路）的解剖学和可行性研究，以便使用 Tomita 技术整块切除第二胸椎。为应用该技术，必须同时处理椎体的两侧。但在颈椎胸椎交界区，这样的操作非常困难，因为肩胛骨及其肌肉是椎旁间隙和椎体侧方的解剖学屏障。
为了研究颈椎胸椎交界区的扩大后外侧 Fessler 入路以及在第二胸椎上应用 Tomita 技术的可能性，南特大学人体解剖学实验室使用了 3 具新鲜冷冻尸体。
该入路可显露第二胸椎的后弓和体部，无需对浅层和深层后胸肌进行明显的切除或牵引，从而能够应用 Tomita 技术并有助于术中脊柱固定。
所提出的手术技术在技术上是可行的。然而，它应该是一种为特定患者保留的选择，对于这些患者，手术的复杂性可以通过其恶性肿瘤的特征和预期的治疗效果来证明是合理的。
