School of Medicine and Health Sciences Poster Presentations

Title

The Optimal Neurosurgical Management of Unstable High Thoracic Spine Fractures

Poster Number

186

Document Type

Poster

Publication Date

3-2016

Abstract

Fractures of the upper thoracic spine, T1­T5, provide a challenging surgical environment, even for the most skilled spinal surgeons. These fractures are difficult to access because of the surrounding structures unique to this location such as the heart, the great vessels, and the apices of the lungs. Currently, these high thoracic fractures can be approached in a variety of ways ­ anterior thoracotomy, lateral extracavitary, posterolateral, or a combination of each of these. Through this study, the authors intend to present an algorithm for the challenging surgical management of T1­T5 pathology resulting in instability or spinal cord injury.

Herein, the authors present a series of 9 patients who presented with T1­T5 pathology resulting in spinal cord compression or unstable fractures that were managed surgically through these various approaches. This analysis compares fusion rates and the perioperative complication rates associated with each of these surgical techniques. This investigation will also analyze and compare pre­ and postoperative neurological examinations, as well as functional ability.

From this study, the authors demonstrate: improvement in overall functional ability, successful fusion rates for all approaches, and no major complications with any case in this series. Additionally, based on our series it was determined that T1­T2 pathology was best managed with the lateral extracavitary approach, whereas T3­T5 pathology was best managed with an anterior thoractomy. However, in the setting of either solely posterior or solely posterolateral pathology with an intact spinal column, a simple posterior decompression with instrumentation was sufficient for stabilization and fusion.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at: GW Research Days 2016

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The Optimal Neurosurgical Management of Unstable High Thoracic Spine Fractures

Fractures of the upper thoracic spine, T1­T5, provide a challenging surgical environment, even for the most skilled spinal surgeons. These fractures are difficult to access because of the surrounding structures unique to this location such as the heart, the great vessels, and the apices of the lungs. Currently, these high thoracic fractures can be approached in a variety of ways ­ anterior thoracotomy, lateral extracavitary, posterolateral, or a combination of each of these. Through this study, the authors intend to present an algorithm for the challenging surgical management of T1­T5 pathology resulting in instability or spinal cord injury.

Herein, the authors present a series of 9 patients who presented with T1­T5 pathology resulting in spinal cord compression or unstable fractures that were managed surgically through these various approaches. This analysis compares fusion rates and the perioperative complication rates associated with each of these surgical techniques. This investigation will also analyze and compare pre­ and postoperative neurological examinations, as well as functional ability.

From this study, the authors demonstrate: improvement in overall functional ability, successful fusion rates for all approaches, and no major complications with any case in this series. Additionally, based on our series it was determined that T1­T2 pathology was best managed with the lateral extracavitary approach, whereas T3­T5 pathology was best managed with an anterior thoractomy. However, in the setting of either solely posterior or solely posterolateral pathology with an intact spinal column, a simple posterior decompression with instrumentation was sufficient for stabilization and fusion.