Issa Mohammed, Neumann Jan-Oliver, Al-Maisary Sameer, Dyckhoff Gerhard, Kronlage Moritz, Kiening Karl L, Ishak Basem, Unterberg Andreas W, Scherer Moritz
Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany.
Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany.
J Clin Med. 2023 Jun 17;12(12):4107. doi: 10.3390/jcm12124107.
Surgical access to the cervicothoracic junction (CTJ) is challenging. The aim of this study was to assess technical feasibility, early morbidity, and outcome in patients undergoing anterior access to the CTJ via partial sternotomy. Consecutive cases with CTJ pathology treated via anterior access and partial sternotomy at a single academic center from 2017 to 2022 were retrospectively reviewed. Clinical data, perioperative imaging, and outcome were assessed with regards to the aims of the study. A total of eight cases were analyzed: four (50%) bone metastases, one (12.5%) traumatic instable fracture (B3-AO-Fracture), one (12.5%) thoracic disc herniation with spinal cord compression, and two (25%) infectious pathologic fractures from tuberculosis and spondylodiscitis. The median age was 49.9 years (range: 22-74 y), with a 75% male preponderance. The median Spinal Instability Neoplastic Score (SINS) was 14.5 (IQR: 5; range: 9-16), indicating a high degree of instability in treated cases. Four cases (50%) underwent additional posterior instrumentation. All surgical procedures were performed uneventfully, with no intraoperative complications. The median length of hospital stay was 11.5 days (IQR: 9; range: 6-20), including a median of 1 day in an intensive care unit (ICU). Two cases developed postoperative dysphagia related to stretching and temporary dysfunction of the recurrent laryngeal nerve. Both cases completely recovered at 3 months follow-up. No in-hospital mortality was observed. The radiological outcome was unremarkable in all cases, with no case of implant failure. One case died due to the underlying disease during follow-up. The median follow-up was 2.6 months (IQR: 23.8; range: 1-45.7 months). Our series indicates that the anterior approach to the cervicothoracic junction and upper thoracic spine via partial sternotomy can be considered an effective option for treatment of anterior spinal pathologies, exhibiting a reasonable safety profile. Careful case selection is essential to adequately balance clinical benefits and surgical invasiveness for these procedures.
手术进入颈胸交界区（CTJ）具有挑战性。本研究的目的是评估经部分胸骨切开术前路进入CTJ的患者的技术可行性、早期发病率和治疗结果。对2017年至2022年在单一学术中心接受前路手术和部分胸骨切开术治疗的CTJ病变连续病例进行回顾性分析。根据研究目的评估临床数据、围手术期影像学检查和治疗结果。共分析了8例病例：4例（50%）为骨转移，1例（12.5%）为创伤性不稳定骨折（B3-AO骨折），1例（12.5%）为伴有脊髓压迫的胸椎间盘突出症，2例（25%）为结核和脊椎椎间盘炎引起的感染性病理性骨折。中位年龄为49.9岁（范围：22-74岁），男性占比75%。中位脊柱不稳定肿瘤评分（SINS）为14.5（四分位间距：5；范围：9-16），表明治疗病例存在高度不稳定。4例（50%）患者接受了额外的后路内固定。所有手术均顺利完成，无术中并发症发生。中位住院时间为11.5天（四分位间距：9；范围：6-20），其中在重症监护病房（ICU）的中位时间为1天。有2例患者出现与喉返神经拉伸和暂时性功能障碍相关的术后吞咽困难。2例患者在3个月随访时均完全康复。未观察到院内死亡。所有病例的影像学结果均无异常，无植入物失败病例。1例患者在随访期间因基础疾病死亡。中位随访时间为2.6个月（四分位间距：23.8；范围：1-45.7个月）。我们的系列研究表明，经部分胸骨切开术对颈胸交界区和上胸椎进行前路手术可被视为治疗前路脊柱病变的有效选择，具有合理的安全性。对于这些手术，仔细的病例选择对于充分平衡临床益处和手术侵袭性至关重要。
