Anterior exposure of the cervicothoracic spine using a combined cervical and thoracic approach.

Micheli, L J; Hood, R W

doi:10.2106/00004623-198365070-00015

Cited by 56 publications

(26 citation statements)

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“…14 following an anterior surgical procedure to cervicothoracic junction, many authors 8,12,15,16,21,23,24,26,29,32,33 believe that the direct anterior approach to the region is safe and effective, as demonstrated in our cases. We had only two complications: a local hematoma and a lung infection.…”

Section: Discussionsupporting

confidence: 57%

“…Posterior approaches are disadvantageous because of a destabilization effect, inadequate visualization of the vertebral body pathology, and the need for a long posterior construct to restore stability with a higher rate of complications than anterior or lateral approaches 4,15,28,30 . These limitations maintain the further development of various posterolateral and anterior approaches 4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]29 . The first description of a posterolateral approach in the cervicothoracic area was the costotransversectomy, described in 1894 by Ménard 22 .…”

Section: Discussionmentioning

confidence: 99%

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Anterior approach to the cervicothoracic junction: case series and literature review

Falavigna

Righesso²,

Filho

et al. 2009

Coluna/Columna

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Objectives: the authors report their experience with the anterior approach to the cervicothoracic junction at C7 to T4 vertebral bodies, how the radiological investigation was performed in order to define the need for manubriotomy, how was the surgical pitfalls and the clinical evaluation. Methods: prospective cohort study with 14 patients who underwent an anterior approach to the cervicothoracic surgery during the period of January 1996 to January 2009. The patients underwent radiographic evaluation with computed tomography and magnetic resonance before surgery in order to identify when the manubriotomy was necessary. The surgery was usually performed from the left side through an anterior Smith-Robinson approach and manubriotomy when necessary. Mesh and cervical plate system were used for stabilization when corpectomy was performed. Nevertheless, in RESUMOObjetivo: relatar a experiência dos autores no acesso anterior da junção cervicotorácica C7 a T4, em relação à definição de quando é necessária a realização da manubriotomia, quais as particularidades desta cirurgia e a avaliação dos resultados. the cases with discal herniation C7-T1, the reconstruction was done with PEEK and cervical plate system. Results: the mean age was 63 years old (range, 30-77 years) and seven of the patients were men. The majority of cases had metastatic disease (n=8) or disc herniation (n=4). There were two complications related to the surgical procedures: one patient with dysphonia caused by a local hematoma and other one with lung infection. The mean surgical time, bleeding volume, pain intensity, medication intake and length of hospital stay were lower in the cases in which manubriotomy was not necessary. Conclusions: the anterior approach to the cervicothoracic junction is effective and presents low morbidity rate. In cases of injuries involving the C7 vertebral body and C7-T1 intervertebral disc herniation, a transcervical approach without the manubriotomy was indicated; when a T1 and/or T2 corpectomy was necessary, the transmanubrial approach usually was necessary in order to provide a good working space to perform a corpectomy and reconstruction. Performing manubriotomy increases surgical time, bleeding, pain intensity, analgesic drugs intake and the length of hospital stay. KEYWORDS:

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Anterior approach to the cervicothoracic junction: case series and literature review

Falavigna

Righesso²,

Filho

et al. 2009

Coluna/Columna

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show abstract

“…The limitations of a posterior exposure have resulted in the development of various posterolateral and anterior approaches [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]29 . The first description of a posterolateral approach to the cervicothoracic area was the costotransversectomy described in 1894 by Ménard 22 .…”

Section: Discussionmentioning

confidence: 99%

Anterior surgical management of the cervicothoracic junction lesions at T1 and T2 vertebral bodies

Falavigna

Righesso²,

Pinto-Filho

et al. 2008

Arq. Neuro-Psiquiatr.

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-Lesions of the cervicothoracic junction have a high propensity for causing instability and present unique challenges in the surgical treatment. Several surgical approaches to this region have been described in the literature. We report our experience in the surgical treatment of six patients with unstable lesions involving the cervicothoracic junction at T1 and T2 vertebral bodies. The patients underwent an anterior left Smith-Robinson approach and manubriotomy. Mesh and cervical plate system were used for stabilization and reconstruction of the region. No complication related to the surgical procedure was observed. In our experience, in injuries involving the T1 and T2 vertebral bodies, the transmanubrial approach offers good working room to remove the lesions and anterior reconstruction.KEY WORDS: spine, cervicothoracic junction, instability, surgical treatment. Manejo cirúrgico via anterior das lesões da junção cérvico-torácica nos corpos vertebrais de T1 e T2Resumo -Lesões da junção cérvico-torácica têm alta tendência em causar instabilidade e apresentam grandes desafios ao tratamento cirúrgico. Diversas abordagens cirúrgicas a esta região foram descritas na literatura. Relatamos nossa experiência no tratamento cirúrgico de seis pacientes com lesões instáveis envolvendo a junção cérvico-torácica em corpos vertebrais de T1 e T2. Os pacientes foram submetidos a uma abordagem anterior de Smith-Robinson pela esquerda e manubriotomia. Mesh e placa cervical foram utilizados para estabilização e reconstrução da região. Nenhuma complicação relacionada ao procedimento cirúrgico foi observada. Em nossa experiência, em lesões que envolvem os corpos vertebrais de T1 e T2, a abordagem transmanubrial oferece bom campo de trabalho para remoção das lesões e estabilização anterior.

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“…The surrounding rib cage provides support, but also acts as an obstacle to plain radiography and surgical access. Different approaches are described in the literature [4,7,9,[11][12][13][14]. To have sufficient manual working room, the sternotomy approach first described in 1957 [12] is recommended because transpleural approaches to the upper thoracic spine inadequately expose the lower cervical spine; standard approaches to the cervical spine may offer good exposure to T1, but the working room more distally is poor.…”

Section: Discussionmentioning

confidence: 99%

Surgical management for upper thoracic spine tumors by a transmanubrium approach and a new space

et al. 2006

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The anterior aspect of the upper thoracic spine is a difficult region to approach in spinal surgery. Many vital structures including osseus, articular, vascular and nervous ones hinder the exposure. With increasing frequency, spine surgeons are being asked to provide decompression and stabilization in patients with spinal tumors .The traditional exposure is between the esophagus and trachea medially and the left common carotid or the brachiocephalic artery (BCA) laterally, and the disadvantages were that the ligation and section of the left innominate vein is proposed to reach T4 and the injury of the thoracic duct could occur. The right space of the BCA or the ascending aorta (AA) (the exposure between the right brachiocephalic vein and the BCA or between the AA and superior caval vein) is recommended in exposing the upper thoracic vertebrae; this new space is technically feasible; the exposure is sufficient for vertebral body resection and reconstruction and fixation. Twentyeight patients with upper thoracic spine tumors underwent surgery by the use of this new space between June 2000 and October 2005. A strut graft was fixed anteriorly after decompression of the spinal cord. Levels C7-T5 can be well exposed through this new space, allowing complete vertebral body removal at level T1-T4. After body removal, the posterior longitudinal ligament is well exposed, allowing complete release of the spinal cord. Curettage was performed in one case of aneurysmal bone cyst and three cases of bone giant cell tumors. For other tumors, vertebrectomies or sagittal resections were performed. Four patients underwent surgery by a combination of anterior and posterior approach.

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Anterior exposure of the cervicothoracic spine using a combined cervical and thoracic approach.

Cited by 56 publications

References 0 publications

Anterior approach to the cervicothoracic junction: case series and literature review

Anterior approach to the cervicothoracic junction: case series and literature review

Anterior surgical management of the cervicothoracic junction lesions at T1 and T2 vertebral bodies

Surgical management for upper thoracic spine tumors by a transmanubrium approach and a new space

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