Modified anterior approach to the cervicothoracic junction

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Thoracic Surgery

Background:

• Traditional anterior approaches to the cervicothoracic junction involve extensive sternotomy or clavicular osteotomy.
• These methods carry risks of significant morbidity and complications.
• A simplified, less invasive approach is needed for cervicothoracic spine access.

Purpose of the Study:

• To evaluate a modified anterior approach for cervicothoracic junction access.
• To assess the technique's exposure extent, ease of performance, and postoperative morbidity.
• To determine the safety and efficacy of a partial sternotomy for spinal decompression.

Main Methods:

• A modified anterior approach combining a standard cervical incision with a partial median sternotomy and transverse osteotomy.
• The technique was applied to four patients requiring decompression and stabilization for cervicothoracic junction metastatic disease.
• Innominate vein division was performed in three patients; posterior stabilization followed anterior procedures.

Main Results:

• The modified approach provided excellent surgical exposure from C3 to T4.
• The procedure was technically simple, with minimal additional operative time.
• No morbidity was associated with the partial sternotomy or innominate vein division.

Conclusions:

• Partial sternotomy with a cervical incision is a safe and effective anterior approach to the cervicothoracic junction (C3-T4).
• This technique offers superior exposure while being technically straightforward.
• It mitigates risks of subclavian vessel injury and avoids the morbidity of clavicular resection.