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

Park, Jong‐Hyun; Im, Soo Bin; Jeong, Je Hoon; Hwang, Sun Chul; Shin, Dong-Seung; Kim, Bum‐Tae

doi:10.3340/jkns.2015.58.3.236

Cited by 10 publications

(6 citation statements)

References 16 publications

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“…Next search was done for transmanubrial approach to cervical spine and it found seven case series appropriate for the study [ Table 4]. [15][16][17][18][19][20][21] The transmanubrial approach is 5]. [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] The ACDF is effective up to three levels with neurological improvement in 85%-95% of the patients.…”

Section: Resultsmentioning

confidence: 99%

“…The sternum is approximated with the number three steel wires. 8] [15][16][17][18][19][20][21] The review of our case series suggests that when performed with dissection in appropriate planes, adequate exposure up to T4 levels is obtained, allowing adequate reconstruction of the spine. Despite immediate postoperative pain, there is an improvement in the clinical outcomes of the patient.…”

Section: Techniquementioning

confidence: 98%

“…Vocal cord paresis due to recurrent laryngeal nerve injury [15][16][17][18][19][20][21] has been reported in 4.76%-16.67% of patients. Various causes include direct injury, traction injury to nerves [114] at the point of upturn, anatomic variations, and misidentification of the nerve, leading to en masse ligation of the inferior thyroid vessels along with the nerve, rarely due to endotracheal tube compressing the nerve.…”

Section: Outcomes and Complications [Tablementioning

confidence: 99%

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Anterior approach to the cervical spine: Elegance lies in its simplicity

Arumalla

Bansal

Jadeja³

et al. 2021

Asian J Neurosurg

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Introduction: Since the landmark publication by Smith and Robinson, approaches to the cervical spine anteriorly have undergone many modifications and even additions. Nevertheless, at its core, the anterior approach remains an elegant and efficient approach to deal with majority of cervical spine pathologies including the degenerative cervical spine. Methodology: For this review, we searched for all major cases series and randomized control trials of anterior cervical approaches using the PubMed databases. Articles having the details of clinical variables and outcomes were tabulated and analyzed. Results: A total of 9 case series for transoral, 7 case series for transmanubrial, 19 case series for anterior cervical discectomy and fusion (ACDF), 6 studies for ACDF versus posterior cervical foraminotomy, 37 case series for ACDF versus arthroplasty, and 7 studies for ACDF versus anterior cervical corpectomy and fusion have been included. The majority of the case series suggested that the anterior cervical procedures have good clinical outcomes. The upper cervical spine approached by the transoral route had good outcomes in ventral compressive pathologies, with morbidity of cerebrospinal fluid leak in 7% of patients. The midcervical spine approached by ACDF had better clinical outcomes equivalent to the majority of modifications even in multiple-level pathologies. The transsternal approach had provided greater access and stability to the cervicothoracic junction with minimal morbidity. Conclusion: The anterior cervical approach can address the majority of cervical pathologies. They provide adequate corridor from craniovertebral junction to T4 with minimal morbidity, thus providing a good clinical outcome.

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Section: Resultsmentioning

confidence: 99%

Section: Techniquementioning

confidence: 98%

Section: Outcomes and Complications [Tablementioning

confidence: 99%

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Anterior approach to the cervical spine: Elegance lies in its simplicity

Arumalla

Bansal

Jadeja³

et al. 2021

Asian J Neurosurg

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“…Giant tumors of the CTJ have a low incidence rate and are poorly defined. Surgical resection has been established as the most appropriate means of treatment for these tumors (2)(3)(4). Anatomically, the CTJ is a challenging region to access for resection due to the surrounding vital nerves and vascular structures (5).…”

Section: Introductionmentioning

confidence: 99%

Reverse “L” surgical approach for the management of giant tumors of the cervicothoracic junction

Zhong¹,

Yang²,

Jiang³

et al. 2020

J Thorac Dis

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Background: An isolated cervical or thoracic surgical approach provides insufficient exposure for achieving complete resection of tumors of the cervicothoracic junction. This study examines reverse "L" thoracotomy as a surgical approach to these tumors. Additionally, the feasibility, safety, and effectiveness of reverse "L" surgical incision for tumor resection was also analyzed.Methods: Patients with cervicothoracic tumors were identified from an internal database. Subjects were selected on the basis of undergoing reverse "L" thoracotomy from August 2014 to August 2018. The tumor characteristics, surgical technique, completeness of resection, morbidity, and patient outcome were reviewed.Results: All patients successfully underwent resection through reverse "L" surgical approach. No patients needed to undergo full sternotomy. There were 6 neurogenic tumors, 4 thyroid adenocarcinomas, 4 bronchogenic tumors, and 7 other cases in the study. The median operative time was 191.0 min (range, 113.0-348.0 min) and postoperative in-hospital stay ranged from 3 to 7 days. Horner syndrome was observed in 1 case. Hoarseness and lymphatic leakage were evident in 3 and 1 case(s), respectively. Hemidiaphragm paralysis was observed in 1 case. Three cases were unsuccessful in achieving R0 resection. The duration of follow-up ranged from 6 to 42 months. Eleven of 13 patients who underwent resection had no evidence of tumor recurrence. Two patients with metastatic disease died of distant progression within 15 months.Conclusions: Applying reverse "L" surgical approach is safe, feasible, and effective for the resection of giant tumors of the cervicothoracic junction.

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“…Термин «шейно-грудной отдел позвоночника», обозначающий переходную зону между мобильным шейным и более ригидным грудным отделами позвоночника, трактуется в литературе неоднозначно, разными авторами оценивается как включающий C 7 -Th 1 , C 6 -Th 2 или C 6 -Th 3 позвоночные сегменты [1,2]. Переломы на уровне C 6 -Th 3 составляют около 3,5 % всех повреждений позвоночного столба [1,3], при этом в 60-83 % случаев они сопровождаются неврологическим дефицитом [4,5]. В первую оче-редь, это обусловлено относительно узким позвоночным каналом, утолщением шейного отдела спинного мозга и его небольшими резервными пространствами на этом уровне.…”

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The use of manubriotomy in the treatment of complicated injury of the cervicothoracic spine: clinical case report and literature review

et al. 2023

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The paper presents a clinical case report and non-systematic review of the literature on the problem of the manubriotomy use in the treatment of complicated injury of the cervicothoracic spine. Approach to surgical treatment of complicated compression-comminuted fracture-dislocation of the cervicothoracic spine was based on preoperative calculation of angulometric characteristics of the injury and individual characteristics of the patient’s anatomy, including the Tenga criterion. A partial resection of the manubrium of sternum in the area of the jugular notch was performed to ensure safe and stable placement of the cervical fixation plate. Complete restoration of the axis and stability of the spine, and regression of neurological deficit were achieved. The preoperative determination of the Tenga criterion in planning cervicothoracic intervention allows, taking into account the anatomical features of the patients, to assess a zone of optimal visualization, as well as to plan caudal expansion of the approach, including by limited U-shaped manubriotomy.

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

Cited by 10 publications

References 16 publications

Anterior approach to the cervical spine: Elegance lies in its simplicity

Anterior approach to the cervical spine: Elegance lies in its simplicity

Reverse “L” surgical approach for the management of giant tumors of the cervicothoracic junction

The use of manubriotomy in the treatment of complicated injury of the cervicothoracic spine: clinical case report and literature review

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