We report a case of anterior decompression and fusion by the sternum splitting approach for upper thoracic spinal kyphotic deformity caused by tuberculous spondylitis. The patient was a 65-year-old male. He suffered from tuberculous spondylitis at 9 years of age and underwent posterior fusion at that time. He has been suffering from lower limb paresis and weakness since one year ago, and these symptoms are deteriorating gradually. MRI examination showed severe anterior compression of the spinal cord due to kyphosis at the T2-4 level. We performed anterior decompression and fusion by the sternum splitting approach with thoracoscopy, and successfully obtained good results. Although anterior decompression and fusion by the sternum splitting approach has been reported as technically difficult because of dangerous anatomical problems involved, such as major vessels, and depth of surgical approach, these disadvantages were somewhat resolved by using thoracoscopy. We concluded that sternum splitting approach assisted with thoracoscopy is useful for the upper thoracic anterior approach.
