Transaxillary Transthoracic Approach to Upper Dorsal Spine Lesions: An Anatomical Corridor with Muscle Preservation

Abstract

Objective: Conventional methods for anterior upper dorsal spine are not devoid of intra-operative complications due to anatomical constraints, a major blood vessel and vital organs. We analyzed the details of Trans- axillary approach without muscle cutting in tuberculosis, tumor, and traumatic lesions of T2 to T6 and upper limb causalgia.Materials and Methods: A prospective quasi-experimental study was conducted for 3 years included 30 patients presented with dorsal myelopathy due to D2 to D6 vertebral body involvement. Right and left sided approaches were utilized. Medical Research Council grading was used to assess neurological status.Results: Mean age was 32 ± 15 years, which included male 18.60% and female 12.40%. T4 vertebrae were commonly involved. Others were T5, T3 and T6 respectively. The majority of lesions were tuberculosis of the spine (n = 14), tumor (n = 8), trauma (n = 5) and causalgia of upper limb (n = 3). No intra-operative complications occurred, estimated blood was 80-100 ml and operative time was 120-160 minutes. Postoperative complications included pneumonia (n = 1), superficial wound infection (n = 3), death (n = 1). Serial follow up was for 2 years, Patients were discharged with improved neurological status and causalgia patients got immediate post-operative relief.Conclusions: Transaxillary approach is a unique anatomical corridor which is safe, feasible with promising results. It provides optimal decompression, reconstruction with better fixation and alignment in various pathologies of upper dorsal spine.

The Transaxillary Approach as a Direct Route in the Management of Upper Thoracic Spine Pathology: A Technical Note with Case Series

“…Data retrieved mainly from cardiothoracic surgeries indicate significant morbidity and mortality following sternotomy, with an incidence as high as 25% [ 19 , 20 ]. When an anterolateral approach is used, impairment of the latissimus dorsi muscle along with the parascapular muscles leads to restricted shoulder movements in the postoperative period [ 1 ]. Although all the above approaches were successful in treating the pathology, they were invasive and involved the resection of normal structures such as the ribs, muscles, and sternum, which can result in significant morbidity [ 21 ].…”

“…The database was searched for patients with thoracic spine lesions using the codes M-4884. Patients with pathology affecting the first thoracic vertebra up to the sixth thoracic vertebra were classified into the upper thoracic spine group [ 1 ]. Consecutive patients who underwent a transaxillary approach to treat such lesions were included in the study.…”

“…Upper thoracic spine disorders present a challenge to surgeons because of their unique anatomy [ 1 ]. The upper thoracic spine is near vital neurovascular structures, mediastinal viscera, and a narrow thoracic outlet.…”

“…The upper thoracic spine is near vital neurovascular structures, mediastinal viscera, and a narrow thoracic outlet. Surgical access to treat disorders involving the vertebral body or ventral dura of the upper thoracic spine remains debatable [ 1 ]. The posterior spinal approach, which is the workhorse of any spine surgeon, is not feasible in the upper thoracic region because of various anatomical reasons in addition to the presence of a scapula and strong shoulder muscles [ 2 ].…”

“…Various surgical techniques and approaches have been reported across the literature to address upper thoracic spine pathology, including the cervicothoracic, anterior transsternal, anterolateral thoracotomy, posterior, posterolateral, supraclavicular, and lateral parascapular approaches [ 1 , 11 ]. Although these approaches can address the upper thoracic spine pathology, they are invasive and lead to significant postoperative morbidity and muscle weakness [ 11 ].…”