Transaxillary Transthoracic Approach to Upper Dorsal Spine Lesions: An Anatomical Corridor with Muscle Preservation

Abstract

Objective: Conventional methods for anterior upper dorsal spine are not devoid of intra-operative complications due to anatomical constraints, a major blood vessel and vital organs. We analyzed the details of Trans- axillary approach without muscle cutting in tuberculosis, tumor, and traumatic lesions of T2 to T6 and upper limb causalgia.
Materials and Methods: A prospective quasi-experimental study was conducted for 3 years included 30 patients presented with dorsal myelopathy due to D2 to D6 vertebral body involvement. Right and left sided approaches were utilized. Medical Research Council grading was used to assess neurological status.
Results: Mean age was 32 ± 15 years, which included male 18.60% and female 12.40%. T4 vertebrae were commonly involved. Others were T5, T3 and T6 respectively. The majority of lesions were tuberculosis of the spine (n = 14), tumor (n = 8), trauma (n = 5) and causalgia of upper limb (n = 3). No intra-operative complications occurred, estimated blood was 80-100 ml and operative time was 120-160 minutes. Postoperative complications included pneumonia (n = 1), superficial wound infection (n = 3), death (n = 1). Serial follow up was for 2 years, Patients were discharged with improved neurological status and causalgia patients got immediate post-operative relief.
Conclusions: Transaxillary approach is a unique anatomical corridor which is safe, feasible with promising results. It provides optimal decompression, reconstruction with better fixation and alignment in various pathologies of upper dorsal spine.