The anterior cervical approach to the cervicothoracic junction

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Extensive surgical approaches are typically required to access upper thoracic vertebrae.
• Existing methods like thoracotomy, sternotomy, or clavicle resection have limitations in exposure and angle to the cervicothoracic junction.
• The caudal extent of anterior approaches is often limited by mediastinal great vessels.

Purpose of the Study:

• To present a simple anterior cervical approach for single-level vertebral disease at the upper thoracic spine.
• To evaluate the efficacy of this approach for ventral decompression and instrumentation.
• To review the surgical anatomy relevant to the cervicothoracic junction.

Main Methods:

• A retrospective review of five patients undergoing a novel anterior cervical approach for T1 or T2 vertebral disease.
• Surgical technique focused on midline ventral decompression and instrumentation.
• Anatomical review of the cervicothoracic junction, including recurrent laryngeal nerves and thoracic duct.

Main Results:

• The anterior cervical approach provided adequate exposure for decompression and instrumentation at the T1-T2 levels.
• All five patients achieved neurological improvement and axial stability post-operatively.
• The approach allowed for good lateral exposure to uncovertebral joints.

Conclusions:

• A simple anterior cervical approach is a viable and effective option for single-level disease at the upper thoracic spine (T1-T2).
• This technique facilitates midline ventral decompression and achieves favorable clinical outcomes.
• Understanding the surgical anatomy of the cervicothoracic junction is crucial for successful application of this approach.