Extrapleural approach for thoracic vertebral stabilization

Surgical access to the upper thoracic vertebral bodies, defined as T1-T5, remains a technical challenge. The anterior extrapleural approach provides excellent visualization and access to the thoracic vertebrae, however, it remains a challenge due to the presence of the great vessels, sternum and trachea. Herein, we describe the case of a 16-year-old boy with avoidant/restrictive food intake disorder and autism spectrum disorder, who presented with lower limb paraparesis following a traumatic hyperflexion injury. Imaging revealed a T2 pathological burst fracture due to spinal hemangioma and osteopenia. Thoracic vertebral decompression and stabilization were performed through an anterior extrapleural approach using a median sternotomy combined with a lateral cervical incision. This approach provided excellent exposure of the anterior upper thoracic vertebral bodies.