The low anterior cervical approach to the upper thoracic vertebrae: a decision by preoperative MR imaging

Surgical approaches to the upper thoracic spine are fraught with many problems as they involve thoracotomy or sternotomy. We analyzed 102 midsagittal MRI scans to evaluate the level of the sternal notch in relation to the upper thoracic spine, so that if the tangential line through the upper part of the sternal notch passed below the level of the involved vertebra, we could surgically access the involved vertebra by the low anterior cervical approach, which is familiar to most spinal surgeons.

Between January and June 2002, 102 consecutive mid-sagittal T2 weighted MRI scans were evaluated. The line as described above was then drawn on each MRI to assess the level of the involved vertebra.

In 68.7% of the cases, the level of the sternal notch corresponded to T2 and T3. This method of assessing accessibility was used in a patient with a fractured T3 that yielded excellent surgical exposure. It was found that routine use of saturation bands is not needed in upper thoracic spine pathology as it obscured the visualization of the sternal notch in 20% of the cases.

In patients with high thoracic fractures who require surgical decompression and stabilization, pre-operative MR scan and assessing the level of the vertebra in relation to the sternal notch can allow a low anterior cervical approach to be used thus decreasing the patient morbidity related to the surgical approach.