Expansile manubriotomy versus standard approach for accessing ventral cervicothoracic junction disease: Methods to improve the decision-making process

摘要

Surgery for pathology in the bony spine is indicated if there is rapid progress of neurological deficits due to cord compression, spinal instability,unacceptable deformity and pain due to instability affecting the quality of life. The procedures, therefore, could be decompression only,decompression with stabilisation, or stabilisation alone. This depends on the indication. The decision-making process is influenced by other factorslike the need for or suitability of adjuvant treatment, co-morbidities, performance status and life expectancy. Decompression is mandatory ifneurological deficits are acute and rapidly progressive. Stabilisation alone might suffice in patients with longstanding problems, especially whereadjuvant therapy is relevant. There is no blanket rule and decisions are made on an individual case basis after discussion in local multidisciplinaryteam meetings. Surgery is not indicated in all cases.