Thoracic and spine surgeons have become increasingly involved with anterior transthoracic approaches to the thoracic and upper lumbar spine. The major complications reported are potential pulmonary morbidity of a thoracotomy, post-thoracotomy pain, and cardiovascular injury. Some authors have reported technical difficulties, failure to perform the planned surgical strategies, and unfamiliarity with the approaches.

Objectives:

The aim of our study is to define the exact approach for each dorsal and upper lumbar vertebra, figuring out the exact steps and trying to reduce the possibility of vascular injury and pulmonary morbidity with elimination of the post-operative pain, and to improve the surgical exposure to facilitate the spine surgical procedures.

Methods:

Between May 2009 and January 2012, 38 patients received surgery with a thoracic, cervicothoracic, or thoracolumbar approach for dorsal spinal procedures. The choice of approach was dictated by the level and length of spinal involvement, and the surgical approaches could be described in terms of the lesion at four anatomical levels of the spinal column: (1) from C7 to T2; (2) from T2 to T6; (3) from T6 to T12; and (4) from T12 to L3 (C: cervical vertebrae, T: thoracic vertebrae).

Results:

All patients survived surgery with no postoperative mortality, and no major pulmonary complications or cardiac complications were detected (0%). Three patients (0.7%) had wound infection.

Conclusions:

The choice of laterality and type of surgical approach depends on the level and length of vertebral column involvement. Certain surgical principles and techniques will help general thoracic and spine surgeons to improve the quality of surgical exposure and to minimize intraoperative as well as postoperative complications.

Keywords: Dorsal spine, vertebral levels, rib removal, intercostal vessel injury.