Clinical Features of Herniated Disc at Cervicothoracic Junction Level Treated by Anterior Approach

Abstract

ObjectiveThe anterior approach for C7-T1 disc herniation may be challenging because of obstruction by the manubrium and the narrow operative field. This study aimed to investigate the clinical and neurological outcomes of anterior approach for C7-T1 disc herniation.MethodsWe retrospectively evaluated 13 patients who underwent the anterior approach for C7-T1 disc herniation by a single surgeon within a period of 11 years (2003-2014). The minimum follow-up duration was 6 months. We describe the clinical presentation, radiographic findings, neurological outcome, and related complications.ResultsOf 372 patients with single-level anterior discectomy and fusion or artificial disc replacement for cervical disc herniation, 13 (3.5%) had C7-T1 disc herniation. The main clinical presentation was unilateral motor weakness in intrinsic hand muscles (11 patients), along with numbness, pain, and tingling sensation that radiate down the arm to the little finger. Most of the patients improved after surgery via the anterior approach. Ten patients underwent successful anterior discectomy and fusion by the standard supramanubrial Smith-Robinson approach, but 2 needed additional manubriotomy and sternotomy. In 1 patient, we performed surgery at a wrong level because the correct level was difficult to identify intraoperatively. Two patients had transient vocal dysfunction, but none had major complications related to injuries of the great vessels such as the thoracic duct or esophagus.ConclusionFor patients who require direct anterior decompression for C7-T1 disc herniation, the anterior approach is relatively feasible. However, care should be taken to overcome physical constraints by the manubrium and slope.

Surgical management of Diffuse Idiopathic Skeletal Hyperostosis (DISH) causing secondary dysphagia (Narrative review)

“…A standard Smith-Robinson anterior cervical approach is utilized. [24][25][26][27] Large anterior cervical osteophytes are usually the main cause of compression of the esophagus and other anterior structures. Studies on some controversial surgical protocols found that patients who had operative treatment using these protocols had good improvement.…”

Anterior Cervical Discectomy and Fusion combined with thyroid gland surgery, a tailored case and literature review

“…Added difficulties in our case came from the fact that the disc herniation needing repair involved the cervicothoracic junction (CTJ). Anterior approaches to the CTJ are challenging because of the close proximity to the sternal manubrium as well as the steep slope of the vertebral bodies of this particular region (C7/T1 level) [22, 23].…”

Is C7-T1 cervical disc replacement a viable technique: A case series

“…Anterior cervical decompression and fusion (ACDF) is an effective treatment for many patients with pathology at C7-T1 [1] , [2] , [4] , [5] , [6] . There is little data regarding the results of cervical disc replacement (CDR) at the cervicothoracic junction.…”