The surgical treatment by the direct anterior approach to the upper thoracic spine is seldom necessary, but it may be technically difficult because of the vital structures in the region.
We report one case with the spinal cord tumor at the lower cervical and upper thoracic region, treated by the sternum splitting approach and the free vascularized fibular graft. The case is a 67-year-old female, presented with gradually progressive weakness of lower extremities and retension of urine. MRI examination revealed the spinal cord tumor at the ventral C6-Th2 region. The tumor was resected anteriorly using the sternum splitting approach and the reconstruction of the vertebral defect was performed by the free vascularized fibular graft, 7.5cm in length. Histological examination showed meningioma. There was a good neurological recovery and no complication.
Hodgson et al reported a 40% mortality rate with this sternum splitting approach in 1960, but the recent Japanease reports have showed no serious complications. We guess that the sternum splitting approach can be performed relatively in safety with a careful respiratory management.
