CASE REPORT: 86 year old female patient arrived with the complaint of severe neck pain with no neurolgical

deficit. MRI of the cervical region revealed a compression fracture of the first thoracal vertebrae which compressed the spinal cord. The lesion was thought to be secondary to a metastatic tumor and after completing the pre-operative examinations, she was operated under general anesthesia. The patient was positioned supine with the pillows under the shoulders for mild extension of the neck. The 5 cm long incision was located horizontally parallel to the right sided clavicula. After sharp dissection of subcutaneous tissue and the platysma, medial border of the sternocleidomastoid muscle was found. With finger tip blunt dissection, we reached the anterior part of the vertebrae, taking great caution not to damage the carotid artery. We used a C-arm to locate T1 and then we de-attached the medial borders of the longus colli muscles bilaterally to produce a gap for placing the self retaining retractors. C7-T1 disc space was visualised by direct vision and after changing the angle of the microscope 20 degrees, we could easily see the second thoracic vertebrae. Anterior longitidunal ligament at both C7-T1 and T1-2 disc spaces was cut with a 15 no blade and disc tissue was removed. It was easy to resect the attacked vertebrae corpus by using curettes. Bleeding was controlled by bone wax while curetting the bone. After we saw the posterior longitidunal ligament at the bottom, we placed a cylindirical cage between the 7th cervical and the second thoracic vertabraes under traction of the head. After hemoastasis we checked the position of the cage by C-arm and closed the layers by single sutures. No complications occurred during or after the surgery and the patient mobilised at the first postoperative day. X-ray revealed that the axis of the vertebral colon was normal. At the 7th postoperative day the patient was referred to oncology department because of the diagnosis of metastatic adenocarcinoma by histologic examination. At the end of the first year she was alive with no neurologic deficit and repeated X-rays showed that the vertebral colon at the operation site was stable.