Anterior approach to the cervicothoracic junction: proposed indication for manubriotomy based on preoperative computed tomography findings

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The purpose of this study was to present straightforward preoperative methods to define the need for manubriotomy in the anterior surgical approach to the cervicothoracic junction.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Preoperative MR imaging and CT scanning studies were performed in all patients. The CT images with sagittal reconstructions including the manubrium were done to apply the so-called surgeons' view line. This line is parallel to the inferior plateau of the superior healthy vertebrae or the vertebrae above the herniated intervertebral disc, and the decision concerning the need for manubriotomy depends on the correlation between this line and the manubrium.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Preoperative planning of the need for manubriotomy was correct in all cases. Manubriotomy was never performed in C-7 corpectomy or C7–T1 discectomy cases; nevertheless, manubriotomy was needed in half of the cases when the T-1 corpectomy was the lowest level to be resected (8 cases), and in 4 cases the lowest level to be approached was T-2. The mean surgical time, bleeding volume, postoperative pain intensity, and length of hospital stay were less in the cervicotomy than in the manubriotomy group.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>By using the surgeons' view line and its correlation with the manubrium, the need for manubriotomy can be predicted without compromising decompression and reconstruction. The statistical differences observed in the surgical variables between the manubriotomy and cervicotomy cases justified the use of preoperative evaluation of the need for manubriotomy as an aid to surgical planning and to give the patient and family realistic expectations about the surgery.</jats:p></jats:sec>

Transaxillary Transthoracic Approach to Upper Dorsal Spine Lesions: An Anatomical Corridor with Muscle Preservation

“…Patients also experienced severe postoperative pain, spinal instability and hematoma formation. 22 In comparison to both above mentioned study, our technique is profoundly safe, we encountered 80 -100 ml blood loss, average operative time was 120 -160 minutes, more than 90% neurological improvement, we experienced 0% mortality related to procedure, none of our patient got a CSF leak or dural tear. There was mild to moderate postoperative pain which was successfully managed with NSAID.…”

The Transmanubrial Approach for Cervicothoracic Junction Lesions : Feasibility, Limitations, and Advantages

“…The CTJ or upper thoracic spine causes more strain on the post-fusional segment postoperatively because of the transition area from a mobile, lordortic cervical to a rigid, kyphotic thoracic spine. Since the midline full sternotomy was described by Cauchoix and Binnet in 1957, various modified approaches for CTJ lesions have been tried 1 3 4 5 7 8 10 12 13 14 16) .…”

“…The anterior approach enables direct decompression by removing the pathology and provides efficient stabilization without damaging the posterior element, but anterior surgical approach to the CTJ is still challenging due to the anatomical structure and complex regional biomechanics 11) . Although several methods are available to help the spine surgeon decide whether do perform a manubriotomy, some remain controversial 2 4 7 8 16) . We report on the technical feasibility and limitations of the transmanubrial approach for CTJ lesions and emphasize the advantage of bisecting the upper part of the manubrium in an inverted Y-shape.…”

Surgical Planning and Neurological Outcome After Anterior Approach to Remove a Disc Herniation at the C7–T1 Level in 19 Patients

“…Once it has been found not to have vascular restrictions, the surgeons should decide whether the manubrium is an obstacle to the surgical approach. 16 The need to perform the manubriotomy only depends on the relationship between the surgeons' view line and the manubrium. Despite these anatomical features of the CTJ, the surgeons' view line drawn on a sagittal MR image crossed over the manubrium in all our cases.…”

“…18 -20 A previous publication by the Falavigna et al 15 establishes a surgeons' view line that was drawn on computed tomographic scan (CT) or magnetic resonance image (MRI) to determine when a standard cervical approach can be performed without the need for manubriotomy to approach the CTJ. 16 The purpose of this study is to assess the radiological diagnosis, the clinical presentation, the neurological outcome and the surgical planning of an anterior approach to disc herniations at the C7-T1 level.…”