Inferiorly Migrated Disc Fragment at T1 Body Treated by T1 Transcorporeal Approach

Upper thoracic vertebral bodies are difficult to access using standard anterior approaches. It may require sternotomy and claviculectomy, which carries significant possibility of morbidities. We report a case of inferiorly migrated cervicothoracic junction disc treated successfully by anterior upper-vertebral transcorporeal approach. This specific technique obviated the need of sternotomy, created favorable working space and saved the motion segment at cervicothoracic junction. This report is the first transcorporeal approach to a disc fragment at T1-2 space without fusion.

Analysis of Factors Related to Neurological Deficit in Thoracolumbar Fractures

OBJECTIVE: The purpose of this study is to determine the factors that have effects on the neurological deficit in the patients with thoracolumbar fracture. METHODS: Forty-eight patients were included. Cause of injury, type of injury, time interval, combined injury, kyphotic angle, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, transverse diameter, the most narrow transverse diameter, and remained height of vertebra body were concerned as the factors. The patients with American Spinal Injury Association(ASIA) impairment scale grade A to D were considered as having neurology while others with ASIA grade E were considered to be without neurology. The patients with ASIA grade A were classified to paraplegia group and the patients with ASIA grade B to E were not thought to be paraplegia. Statistical analysis for these groups were performed. RESULTS: Spinal canal compromise (P<0.001) have correlation with neurological deficit. The most narrow sagittal diameter was smaller in the group with deficit than that in the group without deficit (P=0.004). Also, combined injury have correlation with neurology (P=0.028). Spinal canal compromise (P<0.001), sagittal diameter (P=0.032), the most narrow sagittal diameter (P=0.025), and Denis type (P<0.001) also have correlation with paraplegia. CONCLUSION: The factors of percentage of spinal canal compromise, the most narrow sagittal diameter, and combined injury are predictive of neurological deficit. The patients with paraplegia may be predicted by the factors such as type of injury, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, and Denis type.