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

Abstract

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.

An RCT study on the feasibility of anterior transpedicular screw fixation in the cervicothoracic junction

“…The entry angle indicates the angle between the sagittal pedicle axis and the vertical line exposure due to the bony obstructions of the thorax. In turn, it is associated with a relatively high risk of neurovascular injury within the thoracic outlet, infections, bone instability, and may even influence the function of the shoulder joint [26]. We suggest that the technology of ATPS in the CTJ be used in the following circumstances in particular: (1) patients who underwent anterior/anteroposterior approach surgery and need an anterior revision surgery; and (2) patients who have planned to have an anteroposterior approach surgery, which could be replaced by an anterior only approach.…”

Cervicothoracic Junction Approach using Modified Anterior Approach: J-type Manubriotomy and Low Cervical Incision

“…This is especially true for commonly needed anterior approach lesions in the vertebral body. However, the kyphosis of the upper thoracic spine make the vertebral bodies hard to locate due to its depth, and the presence of neurovascular and osseous obstacles limit the surgical approach 6101115). To decrease the surgical risk, a thoracic surgeon may aid exposure.…”

“…However, traditional anterior low cervical approach limits additional work field for procedures such as anterior plating, corpectomy because of the anterior bony structure. Previous authors have mentioned such problems 6). The sternal manubrium and clavicles often interrupt access to the upper thoracic level (T1–T3).…”

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.…”