Modified Anterior Approach to the Cervicothoracic Junction

Kurz, Lawrence T.; Pursel, Stewart; Herkowitz, Harry N.

doi:10.1097/00007632-199110001-00018

Cited by 75 publications

(45 citation statements)

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“…This is especially true for lesions in the vertebral body, in which an anterior approach is commonly needed. Because of the deep location of vertebral bodies due to the kyphosis of the upper thoracic spine and the presence of neurovascular and osseous obstacles over the operative field in this region, surgical access is often limited [15,17,22,25]. As for neurovascular obstacles, such as the brachiocephalic veins, thoracic duct, and recurrent laryngeal nerves, they can be easily injured which might lead to significant complications [10,12,19,25].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Anterior approaches to the CTJ remain challenging because of the close proximity of vital vascular and neural structures over the operative field and the osseous obstacles caused by the manubrium sterni, clavicles and ribs [15,17,22,23].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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“…This approach was followed by several different modifications of the low anterior cervical technique including median sternotomy and fracturing of the medial half of the clavicle; 18 median sternotomy with biclavicular resection; 11 midclavicular resection leaving the manubrium intact (Fig. 5, Approach 4); 8 creation of an interaortocaval subinnominate window to allow access to the upper thoracic spine; 4 and a transmanubrium approach with a corridor between the brachiocephalic trunk and the ascending aorta. 25 The sternum-splitting technique allows direct visualization of T-1 to T-4 and is considered the most invasive (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Kurz and colleagues 8 were able to show that resection of the manubrium was not necessary to gain access down to T-4 through resection of the medial half of the clavicle. Recent MR imaging studies have shown that a line drawn from the sternal notch perpendicular to the thoracic spine intersects the spine at T-2 or T-3 in approximately 62%-68% of cases.…”

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confidence: 99%

An anterior approach to spinal pathology of the upper thoracic spine through a partial manubriotomy

Lam¹,

Groff²

2011

SPI

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Surgical pathology in the region of the upper thoracic spine (T1–4) is uncommon compared with other regions of the spine. Often times posterior and posterolateral approaches can be used, but formal anterior decompression often requires a low anterior cervical approach combined with a sternotomy, which yields significant perioperative morbidity. The authors describe a modified low anterior cervical dissection combined with a partial manubriotomy that they have used to successfully access and decompress anterior pathology of the upper thoracic spine. Their modified approach spares the sternoclavicular joints and leaves the sternum intact, decreasing the morbidity associated with these added procedures.

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“…To have sufficient manual working room, the sternotomy approach first described in 1957 [12] is recommended because transpleural approaches to the upper thoracic spine inadequately expose the lower cervical spine; standard approaches to the cervical spine may offer good exposure to T1, but the working room more distally is poor. Another advantage is that it does not interfere with shoulder function like the high anterior transthoracic approach by Hodgson et al [8] or the modified anterior approach to the cervicothoracic junction described by Kurz et al [10]. Disadvantages are that the operative wound is narrow and deep [1].…”

Section: Discussionmentioning

confidence: 99%

Surgical management for upper thoracic spine tumors by a transmanubrium approach and a new space

et al. 2006

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The anterior aspect of the upper thoracic spine is a difficult region to approach in spinal surgery. Many vital structures including osseus, articular, vascular and nervous ones hinder the exposure. With increasing frequency, spine surgeons are being asked to provide decompression and stabilization in patients with spinal tumors .The traditional exposure is between the esophagus and trachea medially and the left common carotid or the brachiocephalic artery (BCA) laterally, and the disadvantages were that the ligation and section of the left innominate vein is proposed to reach T4 and the injury of the thoracic duct could occur. The right space of the BCA or the ascending aorta (AA) (the exposure between the right brachiocephalic vein and the BCA or between the AA and superior caval vein) is recommended in exposing the upper thoracic vertebrae; this new space is technically feasible; the exposure is sufficient for vertebral body resection and reconstruction and fixation. Twentyeight patients with upper thoracic spine tumors underwent surgery by the use of this new space between June 2000 and October 2005. A strut graft was fixed anteriorly after decompression of the spinal cord. Levels C7-T5 can be well exposed through this new space, allowing complete vertebral body removal at level T1-T4. After body removal, the posterior longitudinal ligament is well exposed, allowing complete release of the spinal cord. Curettage was performed in one case of aneurysmal bone cyst and three cases of bone giant cell tumors. For other tumors, vertebrectomies or sagittal resections were performed. Four patients underwent surgery by a combination of anterior and posterior approach.

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Modified Anterior Approach to the Cervicothoracic Junction

Cited by 75 publications

References 0 publications

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

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

An anterior approach to spinal pathology of the upper thoracic spine through a partial manubriotomy

Surgical management for upper thoracic spine tumors by a transmanubrium approach and a new space

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