Anterior transsternal approach for treatment of upper thoracic vertebral tuberculosis

Objective:  To study an anterior transsternal approach for treatment of upper thoracic vertebral (Tl-T4) tuberculosis (TB). Methods:  Sixteen patients with upper thoracic vertebral TB underwent anterior decompression and fusion through an anterior transsternal approach. There were nine men and seven women with a mean age of 48.6 ± 2.3 years (range, 37 to 72 years). The involved area included Tl in three patients, T2 in one, T2 and T3 in four, T3 in two, T3 and T4 in four, and T4 in two. The “inside window of the brachiocephalic artery” was used to access T1 and T2 lesions, and the “outside window of the brachiocephalic artery” for T3 and T4 lesions, for T2 and T3, both “windows” were used. According to the Frankel grading system, two patients were of Grade A, one Grade B, two Grade C, six Grade D and five Grade E. The kyphosis Cobb's angle ranged from 15°–40° (mean, 22°± 2.5°) preoperatively. Results:  All patients tolerated surgery wel1. The operation time was 120–150 minutes and bleeding during operation 300–600 ml. The kyphosis Cobb's angle ranged from 10°–25° (mean, 17°± 2.5°) postoperatively. Eight patients with preoperative neurologic deficit had improved. During the follow-up period, all cases healed without any recurrence. There was no failure of internal fixation. Spinal bone fusion occurred after 3–6 months (mean, 4.2 months) after bone graft in all patients. Conclusion:  The anterior transsternal approach provides safe and effective access for surgical treatment of upper thoracic TB.