A perspective for the selection of surgical approaches in patients with upper thoracic and cervicothoracic junction instabilities

Kaya, Ramazan; Türkmenoğlu, Osman; Koç, Omer N.; Genç, Hacı Ali; Çavuçoğlu, Halit; Ziyal, Ibrahim M.; Aydın, Yunus

doi:10.1016/j.surneu.2005.08.017

Cited by 48 publications

(63 citation statements)

References 47 publications

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“…14 following an anterior surgical procedure to cervicothoracic junction, many authors 8,12,15,16,21,23,24,26,29,32,33 believe that the direct anterior approach to the region is safe and effective, as demonstrated in our cases. We had only two complications: a local hematoma and a lung infection.…”

Section: Discussionsupporting

confidence: 56%

“…Posterior approaches are disadvantageous because of a destabilization effect, inadequate visualization of the vertebral body pathology, and the need for a long posterior construct to restore stability with a higher rate of complications than anterior or lateral approaches 4,15,28,30 . These limitations maintain the further development of various posterolateral and anterior approaches 4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]29 . The first description of a posterolateral approach in the cervicothoracic area was the costotransversectomy, described in 1894 by Ménard 22 .…”

Section: Discussionmentioning

confidence: 99%

“…In 1991, Fessler et al 13 proposed the parascapular extrapleural lateral approach, which provides improved exposure of all the upper thoracic vertebrae. The disadvantages of this procedure are: prolonged surgery (10-12 hours), excessive blood loss and inefficiency for the pathologies extending into the C7 vertebrae 15 . Furthermore, lung-related complications are common after this approach 31 .…”

Section: Discussionmentioning

confidence: 99%

“…In our experience, in lesions extending until the C7 vertebral body or C7-T1 interverterbral disc, we may have good exposure and working space with the supramanubrial cervicotomy. For treating the pathologies below T1, with a partial sternotomy (manubriotomy) we are able to reach T4, but not to achieve additional caudal exposure despite using a complete sternotomy, because of the limited retraction of the aortic arc 15 , and this procedure can minimize the risks of substernal dissection 21 . Upper lateral transthoracic or extrapleural approach is mandatory for total removal and reconstruction of the lesions of T4 and below 15 .…”

Section: Discussionmentioning

confidence: 99%

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Anterior approach to the cervicothoracic junction: case series and literature review

Falavigna

Righesso²,

Filho

et al. 2009

Coluna/Columna

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Objectives: the authors report their experience with the anterior approach to the cervicothoracic junction at C7 to T4 vertebral bodies, how the radiological investigation was performed in order to define the need for manubriotomy, how was the surgical pitfalls and the clinical evaluation. Methods: prospective cohort study with 14 patients who underwent an anterior approach to the cervicothoracic surgery during the period of January 1996 to January 2009. The patients underwent radiographic evaluation with computed tomography and magnetic resonance before surgery in order to identify when the manubriotomy was necessary. The surgery was usually performed from the left side through an anterior Smith-Robinson approach and manubriotomy when necessary. Mesh and cervical plate system were used for stabilization when corpectomy was performed. Nevertheless, in RESUMOObjetivo: relatar a experiência dos autores no acesso anterior da junção cervicotorácica C7 a T4, em relação à definição de quando é necessária a realização da manubriotomia, quais as particularidades desta cirurgia e a avaliação dos resultados. the cases with discal herniation C7-T1, the reconstruction was done with PEEK and cervical plate system. Results: the mean age was 63 years old (range, 30-77 years) and seven of the patients were men. The majority of cases had metastatic disease (n=8) or disc herniation (n=4). There were two complications related to the surgical procedures: one patient with dysphonia caused by a local hematoma and other one with lung infection. The mean surgical time, bleeding volume, pain intensity, medication intake and length of hospital stay were lower in the cases in which manubriotomy was not necessary. Conclusions: the anterior approach to the cervicothoracic junction is effective and presents low morbidity rate. In cases of injuries involving the C7 vertebral body and C7-T1 intervertebral disc herniation, a transcervical approach without the manubriotomy was indicated; when a T1 and/or T2 corpectomy was necessary, the transmanubrial approach usually was necessary in order to provide a good working space to perform a corpectomy and reconstruction. Performing manubriotomy increases surgical time, bleeding, pain intensity, analgesic drugs intake and the length of hospital stay. KEYWORDS:

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anterior approach to the cervicothoracic junction: case series and literature review

Falavigna

Righesso²,

Filho

et al. 2009

Coluna/Columna

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“…The limitation of these two approaches is the restricted access to the low cervical region and the upper 2 thoracic vertebrae due to the scapula and the remaining ribs [12,14].…”

Section: Discussionmentioning

confidence: 99%

Mini-open anterior approach to the cervicothoracic junction: a cadaveric study

et al. 2013

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Purpose To investigate the feasibility of mini-open anterior approach to the cervicothoracic junction (CTJ) in cadaveric specimens. Methods Four adult fresh-frozen cadaveric specimens were used for this study. On the cadaveric specimen, an osteotomy window was made in manubrium sterni to remove the bony obstacle. To bypass the vital vascular and neural structures over the operative field, we used the surgical corridor which was located medially by the brachiocephalic artery and laterally by the right brachiocephalic vein, or in combination with another surgical corridor between the ascending aorta and the superior vena cava. And we used a special self-retaining retractor system and an endoscope to facilitate the procedures. Results Surgical procedures performed on the four freshfrozen cadaveric specimens to expose the CTJ through mini-open anterior approach were successful. The anterior surface of C6-T5 could be exposed, allowing complete decompression and application of locking plate and screws. The most caudal accessible vertebral body was T5 vertebral body in our study. Conclusion It is feasible to expose the CTJ through this mini-open anterior approach.

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Thoracic Lateral Extracavitary Decompression and Fusion

Witiw

Fessler

2017

Essentials of Spinal Stabilization

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A perspective for the selection of surgical approaches in patients with upper thoracic and cervicothoracic junction instabilities

Cited by 48 publications

References 47 publications

Anterior approach to the cervicothoracic junction: case series and literature review

Anterior approach to the cervicothoracic junction: case series and literature review

Mini-open anterior approach to the cervicothoracic junction: a cadaveric study

Thoracic Lateral Extracavitary Decompression and Fusion

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