serratus anterior elevation approach to the upper four thoracic vetebrae: technical note based on a case report

ABSTRACT

This study modified the conventional anterior scapular releasing approach to the upper thoracic vertebrae in the following way The spine was approached through a T-shaped incision. The trapezius and rhomboids were released along their origins from the spine up to the neck and the latissimus dorsi cut transversely as caudally as possible. Two triangular musculocutaneous flaps were elevated, the upper one including the trapezius, rhomboids and a major part of the latissimus dorsi, the lower one the inferior part of the latissimus dorsi. In this way, the scapula and serratus anterior were exposed. Next, by detaching the serratus anterior origin from the chest wall, the whole scapula was mobilized and included in the upper flap. This approach was used to decompress the spinal cord in a 72-year old patient suffering of paraplegia because of D2/D3 thoracic disc herniation on top of cervicothoracic canal stenosis, ossification of the posterior longitudinal ligament and of the ligamentum flavum. A combined anterolateral rachotomy and anterior retropleural decompression through the fourth intercostals space were used. The operative course was uneventful. Recovery was limited to disappearance of spasticity, regaining of bladder and rectal sensation and to mild improvement in motor power