{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:34:20Z","timestamp":1753893260495,"version":"3.41.2"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T00:00:00Z","timestamp":1693872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The complex anatomical structure of the upper thoracic spine makes it challenging to achieve surgical exposure, resulting in significant surgical risks and difficulties. Posterior surgery alone fails to adequately address and reconstruct upper thoracic lesions due to limited exposure. While the anterior approach offers advantages in fully exposing the anterior thoracic lesions, the surgical procedure itself is highly intricate. Although there exist various anterior approaches for the upper thoracic spine, the incidence of upper thoracic spine lesions is relatively low. Consequently, there are limited reports on the treatment and reconstruction of upper thoracic spine lesions using the third rib small incision approach in the context of upper thoracic tuberculosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We collected data from four patients with upper thoracic tuberculosis who were admitted to our department between July 2017 and November 2022. The treatment for upper thoracic tuberculosis involved utilizing the third rib small incision approach, which included two cases of thoracic 3\u20134 vertebral tuberculosis, one case of thoracic 4 vertebral tuberculosis, and one case of thoracic 5 vertebral tuberculosis. Among the patients, three were positioned in the left lateral position, while one was positioned in the right lateral position. Prior to admission, all four patients received a two-week course of oral medication, consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol. After the surgical procedure, they continued receiving anti-tuberculosis treatment for a duration of 12 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average duration of the surgical procedure was 150\u2005min, with an average blood loss of 500\u2005ml. One patient exhibited symptoms of brachial plexus injury, which gradually improved after careful observation. All patients experienced primary wound healing, and no complications such as pulmonary infection, respiratory failure, or other adverse events were observed. Additionally, one patient showed elevated transaminase levels, leading to a modification in the anti-tuberculosis drug regimen from quadruple therapy to triple therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The treatment of upper thoracic tuberculosis through the third rib small incision technique is a very good surgical approach, which has the advantages of safety and effectiveness.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1236611","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T09:02:11Z","timestamp":1693904531000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The treatment of tuberculosis in the upper thoracic spine using the small incision technique through the third rib"],"prefix":"10.3389","volume":"10","author":[{"given":"Jibin","family":"Ma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zepei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Lan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiwei","family":"Tian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fulin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Miao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1177\/175045891602201104","article-title":"Percival pott; pott\u2019s fracture, pott\u2019s disease of the spine, pott\u2019s paraplegia","volume":"22","author":"Ellis","year":"2012","journal-title":"J Perioper Pract"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S7","DOI":"10.1016\/j.ijid.2021.02.107","article-title":"Global tuberculosis report 2020 - reflections on the global tb burden, treatment and prevention efforts","volume":"113","author":"Chakaya","year":"2021","journal-title":"Int J Infect Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"35","DOI":"10.4103\/njot.njot_25_19","article-title":"Spinal tuberculosis - current management approach","volume":"18","author":"Onuminya","year":"2019","journal-title":"Niger J Orthop Trauma"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1016\/j.spinee.2019.05.002","article-title":"Spinal tuberculosis: a comprehensive review for the modern spine surgeon","volume":"19","author":"Khanna","year":"2019","journal-title":"Spine J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1007\/s00586-012-2470-1","article-title":"One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach","volume":"22","author":"Zhang","year":"2013","journal-title":"Eur Spine J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1186\/s12891-020-03783-4","article-title":"Esophageal perforation following pedicle screw placement for the treatment of upper thoracic spinal tuberculosis: a case report and review of the literature","volume":"21","author":"Wang","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"key":"B7","first-page":"237","article-title":"Anterior surgical approaches to the spine","volume":"21","author":"Cauchoix","year":"1957","journal-title":"Ann R Coll Surg Engl"},{"key":"B8","doi-asserted-by":"publisher","first-page":"189","DOI":"10.3109\/02688699309103477","article-title":"The anterior approach to high thoracic (t1-t2) disc herniation","volume":"7","author":"Rossitti","year":"1993","journal-title":"Br J Neurosurg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"E7","DOI":"10.3171\/foc.2002.12.1.8","article-title":"Anterior cervicothoracic junction corpectomy and plate fixation without sternotomy","volume":"12","author":"Resnick","year":"2002","journal-title":"Neurosurg Focus"},{"key":"B10","first-page":"1021","article-title":"Sternum-splitting approach for ossification of the posterior longitudinal ligament in the cervico-thoracic junction","volume":"12","author":"Yasui","year":"1984","journal-title":"No Shinkei Geka"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.2106\/00004623-200206000-00017","article-title":"Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. 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