Clinal anatomy and significance of anterior surgical approach to upper thoracic spine / 中华骨科杂志

ABSTRACT

Objective To investigate the anatomic relationship between the upper thoracic vertebrae and adjacent structures in anterior approach of upper thoracic spine, an anatomy study was conducted and its clinical significance was evaluated. Methods Twenty upper thoracic spine specimens of adult human cadaver were exposed, measured and studied for their anatomic landmarks. The origin, course of the recurrent laryngeal nerve, thoracic duct and blood vessels and their relationship were measured and analyzed. The advantages and disadvantages of different surgical approaches exposing the upper thoracic vertebrae were also evaluated and compared. Results The right recurrent laryngeal nerve reaches the tracheo-esophageal groove at the level of C6-7 disc in 55% of the specimens and derives from vagus nerve at the level of T1,2. The thoracic duct empties into the systemic venous system from T1 to T1-2 disc space in 75% of the specimens and among them, more than 50% up to T1 level. The left brachiocephalic vein is at T3 in 55% of the specimens; and the aortic arch is at T3-4 disc in 80% of the specimens. The anterior aspect of T3 can be easily exposed through a modified anterior approach to the upper thoracic vertebrae in only 45% of the specimens(9), compared with outside space of the brachiocephalic trunk(between the right brachiocephalic vein and the brachiocephalic trunk and left brachiocephalic vein) in 95% of the specimens (19). Conclusion Surgical approach through outside space of the brachiocephalic trunk is simple and adequate to expose the T3,4 vertebra body and can get more exposed space of 0.5-1 of the vertebra body than through inner space of the brachiocephalic trunk and can be utilized selectively during anterior upper thoracic spine surgery. Attention should be paid to avoid injury of vagus nerve in the middle, right recurrent laryngeal nerve on the right and thoracic duct on the left, respectively.