[Treatment of cervicothoracic junction spinal lesions by modified anterior approach]

To investigate the therapeutic effect of the modified anterior approach in treatment of the patients with cervicothoracic junction spinal lesions.

From September 2000 to January 2005, 23 patients (15 males, 8 females) with spinal lesions in the cervicothoracic junction underwent a standard cervical approach, which was combined with a partial median steotomy and transverse steotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately. Among the patients, 3 had fracture, 7 had dislocation, 6 had tuberculosis, and 7 had tumor. The pathologic change regions was as follows: 2 in the C6-T1 segment, 2 in the C6-T2 segment, 3 in the C7-T1 segment, 3 in the T3 segment, 8 in the T1 segment, and 5 in the T2 segment. The classification of Frankel were as follows: 2 at grade A, 4 at grade B, 7 at grade C, 4 at grade D, and 6 at grade E. All the patients underwent a radical excision of the affected spinal bone, were given a proper tricortical iliac crest and anterior instrumentation to reconstruct the anterior spinal column, followed by immobilization in a brace for 3-6 months.

The mean follow-up period was 30 months (range, 10-42 months). Bony fusion was obtained in all the patients. One patient died of pulmonary cancer metastasis 10 months after operation. The nerve function of the spinal cord recovered at different degrees (1 at grade A, None at grade B, 2 at grade C, 10 at grade D, 10 at grade E).

Our modified anterior approach can provide a direct and safe access to the lesions in the region.