[Sternum-splitting approach for ossification of the posterior longitudinal ligament in the cervico-thoracic junction]

In this paper the author reported an operative approach for ossification of the posterior longitudinal ligament (OPLL) of the lower cervical and upper thoracic vertebrae. There are two types of surgery for OPLL, namely, posterior and anterior approaches. As a rule, we utilize an anterior approach for OPLL. Recently we performed a modified sternum-splitting approach in surgery for OPLL in the cervico-thoracic junction. In the original trans-sternal approach introduced by Cauchoix, the sternum is split from the suprasternal notch to the xiphoid process. We cut the manubrium only. However, a satisfactory exposure of the cervico-thoracic vertebrae down to the third thoracic level was obtained. After reaching the anterior surface of the cervico-thoracic vertebrae, the central portion of the vertebral body and the ossified lesion between the lower one third of the C7 vertebral body and the upper one third of the Th3 vertebral body were removed with an air-drill under an operating microscope. The longitudinal bone defect of the vertebral bodies was filled with a bone graft obtained from the iliac bone. Removal of the ossified lesion in the cervico-thoracic junction can be performed safely by utilizing the modified sternum-splitting approach. This approach can be applied also to endarterectomies at the origins of the vertebral arteries and the right subclavian artery.