Our Summary

This research paper discusses a surgical procedure used in neurosurgery, particularly for problems related to the spine near the neck and chest area. Conducting surgery in this area can be tricky because there are many important nerves and blood vessels present. One method to perform surgery on this area is through a procedure called Median Sternotomy, which allows doctors to directly access the lower neck and upper chest vertebrae (bones of the spine).

The paper presents the first reported case in Ghana, West Africa, of a young man who had a spinal infection due to tuberculosis during his childhood. This led to a condition called osteomyelitis, an infection in the bone, which affected the upper chest vertebrae and also caused pressure on his spinal cord.

To treat this, the young man underwent a full Median Sternotomy. This involved removing pressure from the spinal cord and fusing the affected vertebrae using a bone graft from his hip. The paper goes into detail about the steps involved in this surgical procedure and also reviews other related scientific literature.

FAQs

  1. What is a median sternotomy approach and when is it used in neurosurgery?
  2. How was the median sternotomy approach used in the case of the young man from Ghana with post-tuberculosis osteomyelitis of upper thoracic vertebrae?
  3. What are the risks or challenges associated with the direct anterior approach to the cervicothoracic spine?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sternotomy is to follow post-operative care instructions carefully to ensure proper healing and minimize the risk of complications. This may include avoiding strenuous activities, taking prescribed medications as directed, and attending follow-up appointments with your healthcare provider. It is also important to communicate any concerns or changes in symptoms to your doctor promptly.

Suitable For

Patients who may be recommended sternotomy for anterior exposure of the cervicothoracic spine include those with post-tuberculosis osteomyelitis of the upper thoracic vertebrae with cord compression, spinal tumors, spinal trauma, and degenerative spinal conditions. The approach may also be considered for patients requiring anterior decompression and fusion of the lower cervical and upper thoracic vertebrae.

Timeline

Before sternotomy:

  • Patient presents with symptoms of cord compression, such as weakness, numbness, and difficulty walking
  • Imaging studies, such as MRI or CT scan, are performed to confirm diagnosis and determine extent of compression
  • Patient undergoes pre-operative evaluations, including blood tests and physical examination, to assess overall health and fitness for surgery
  • Surgical team discusses treatment options with patient, including the possibility of a sternotomy for direct anterior decompression and fusion of the affected vertebrae

After sternotomy:

  • Patient undergoes median sternotomy procedure, in which a vertical incision is made along the sternum to access the cervicothoracic junction
  • Surgeons perform anterior decompression and fusion of the affected vertebrae, using autologous bone graft from the patient’s iliac crest
  • Post-operative care includes monitoring for complications, such as infection or spinal instability, and managing pain and mobility issues
  • Patient undergoes physical therapy and rehabilitation to regain strength and function in the affected area
  • Follow-up appointments are scheduled to monitor healing and assess long-term outcomes of the surgery.

What to Ask Your Doctor

  1. What is a sternotomy and why is it necessary for my condition?
  2. What are the potential risks and complications associated with a sternotomy procedure?
  3. How long is the recovery process after a sternotomy?
  4. Will I need any special care or precautions after the procedure?
  5. What are the expected outcomes of a sternotomy for my specific condition?
  6. Are there any alternative treatment options to a sternotomy that I should consider?
  7. How experienced are you in performing sternotomy procedures?
  8. Will I need any additional testing or imaging before the sternotomy procedure?
  9. What type of anesthesia will be used during the sternotomy procedure?
  10. How long will the sternotomy procedure take and how long will I need to stay in the hospital afterwards?

Reference

Authors: Okyere I, Lamina A, Owusu B. Journal: Pan Afr Med J. 2017 Oct 5;28:112. doi: 10.11604/pamj.2017.28.112.12948. eCollection 2017. PMID: 29515730