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Anterior approach to the second thoracic vertebral body for surgical treatment (vertebrectomy, bone grafting, and titanium alloy plate fixation).
The surgical approach to the second thoracic vertebral body is difficult from the anterior side. A 38-year-old woman suffering from plasmacytoma in the second thoracic vertebra showed paraplegia for 2 weeks prior to surgery. X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) examinations indicated breakdown of the second thoracic vertebral body and arch, associated with spinal cord compression. A 99mTc bone scintigram showed accumulation only in the second thoracic vertebra. After one course of chemotherapy with cyclophosphamide and prednisone (CP protocol), surgery was carried out. The incision was made on the right side of the anterior of the neck, from the middle half of the sternocleidomastoideus along the anterior edge to the jugular notch of the sternum. After cutting the platysma, severing the sternohyoideus, splitting the sternothyroid muscle, and forming a compartment between the esophagus and vagina carotica, we extended the incision to the sternum. Without wedging the sternum, we separated tissue from the posterior of the sternum to the second and third thoracic vertebrae, excised the second thoracic vertebra to expose the hard spinal meninges, and removed the tumor in the vertebral canal to release the compression on the spinal cord. An autogeneous bone graft, taken from the right ilium (1.5 x 1.5 x 3 cm in size), was implanted between the first and third thoracic vertebrae, and a spinal titanium alloy plate was used to increase fixation between the first and third thoracic vertebrae from the front. During the surgery, 800 ml of blood was transfused. On the fifth postsurgical day, the patient could walk normally with a neck collar, and the paraplegia was completely alleviated, with no complications.
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