A novel muscle-sparing high thoracotomy for upper thoracic spine resection and reconstruction

Derek T. Bernstein, Wu Zhuge, Shanda H. Blackmon, Rex A.W. Marco

Research output: Contribution to journalArticlepeer-review


Purpose: High thoracotomy allows access to the anterior cervicothoracic and upper thoracic vertebrae; however, traditional techniques transect shoulder girdle muscles, leading to postoperative shoulder dysfunction. Muscle-sparing techniques diminish this concern, but often sacrifice the quality of exposure. We describe a novel muscle-sparing, high thoracotomy approach for the treatment of ventral cervicothoracic and upper thoracic spine lesions. Methods: A novel muscle-sparing, high thoracotomy approach is described, utilizing a midline posterior incision with lateral extension from the lateral decubitus position. Five patients are presented to illustrate the application of this technique in thoracic tumors with intimate spinal involvement. Results: The muscle-sparing, high thoracotomy approach afforded gross total resection and spinal reconstruction in five consecutive patients, including stage IV lung carcinoma with invasion of the T5 and T6 vertebral bodies, two malignant fibrous histiocytomas causing thoracic cord compression, a metastatic T6 lesion of unknown primary with associated cord compression; and a Pancoast tumor. All patients seen at 6 months had full symmetric shoulder range of motion postoperatively. Conclusions: The described muscle-sparing, high thoracotomy approach provides excellent exposure of the ventral cervicothoracic and upper thoracic spine without the morbidity associated with the transection of shoulder girdle muscle bellies. This technique is particularly useful in patients with primary malignant bone tumors requiring en bloc excision and metastatic tumors with large soft tissue components.

Original languageEnglish (US)
Pages (from-to)1567-1574
Number of pages8
JournalEuropean Spine Journal
Issue number7
StatePublished - Jul 1 2018


  • Cervicothoracic spine
  • Muscle-sparing
  • Spinal reconstruction
  • Spinal tumor
  • Thoracotomy
  • Upper thoracic spine

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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