Modified transclavicular-transmanubrial approach to cervicothoracic spine: Revisiting and Renovating the Path – Lessons learned

Abstract

Introduction: A thorough knowledge of the vital structures adds to the safety in approaching the cervicothoracic spine junction. The best described method to reach the spine is via viscero-neurovascular space. We present our experience of 10 cases operated at our institute using the modified transclavicular transmanubrial approach to the cervicothoracic spine pathology.As we gained experience we have used various corridors to the operating field and used a new space to approach the lower cervicothoracic junction spine. Methods: Between February 2011 to August 2015, 10 patients with disease in upper thoracic vertebral body were admitted and evaluated clinically and radiologically. Neurological status in all cases was graded according to Frankel grading system.Patients were followed up with Histopathological reports and treated accordingly. Results: All patients(except metastasis) improved by 1 or 2 grade in post op period. Metastasis patients remained in same grade. Conclusion: Anterior approach with its modifications are the better suited biomechanically for exploring the pathology of cervicothoracic spine,its decompression and stabilization. Also it preserves the stability of shoulder girdle with good neurological and cosmetic outcome.

Sternotomy Approach to the Anterior Cervicothoracic Spine

“…Additionally, the inside or outside window of the brachiocephalic vasculature grants enhanced maneuverability for the reconstruction and stabilization of the four upper thoracic levels [6]. Some surgeons have proposed that the anterior approach via a modified transclavicular-transmanubrial approach with preservation of the sternoclavicular joint is better suited biomechanically for exploring the pathology of the cervicothoracic spine and its decompression and stabilization, granting better neurological outcome with good upper limb stability [9]. Overall, anterior approaches for anterior pathology have been reported to be more feasible than posterior or lateral approaches to anterior pathology, addressing the pathology directly and adequately with reduced operation time, transfusion requirements, early ambulation, maintaining alignment without deformity, and overall decreased injury to paraspinal structures [4,9].…”