Sternotomy Approach to the Anterior Cervicothoracic Spine

Abstract

The anterior cervicothoracic spine is a challenging region to approach given the various vascular, osseous, nervous, and articular structures, which prevent adequate exposure. This region is susceptible to lesions ranging from tumors, degenerative disease, infectious processes, and traumatic fractures. Our objective was to critically evaluate the sternotomy approach in spine surgery to give the technical implications of its usage. The safety and efficacy of the transsternal approach are discussed as well as the advantages, disadvantages, indications, and contraindications. The transsternal approach is the most direct access to pathologies in the upper anterior cervicothoracic spine and enables the spine surgeon to gain direct exposure to the cervicothoracic junction for ideal visualization. Anatomical considerations must be kept in mind while performing a sternotomy to prevent complications such as denervation or bleeding. This technique is useful for the armamentarium of spinal surgeons.

Median sternotomy as a useful adjunct to anterior cervicothoracic spine decompression and fixation: A plea for its popularity among spine surgeons in West Africa

“…Access to T1/T2 is achieved by the dissection of the “inside window” whereas access to T3-T5 can be achieved by the dissection of the “outside window” as compiled by Fiani et al . [ 1 ] However, a trans-thoracic approach may be more suitable for access below T3 to mitigate avoidable access challenges and the risk of major vascular injuries. [ 7 ]…”

“…Partial or full median sternotomy is sometimes advocated to aid access to T2–T4 vertebral bodies for spine surgery. Although Cauchoix and Binet were the first to ventrally approach the cervicothoracic spine by attempting a direct median sternotomy in 1957,[ 1 ] this well-established approach was only first reported in the West African sub-region by Okyere et al . [ 2 ] Where indicated (and with meticulous dissection in experienced hands), median sternotomy provides improved access to as low as T4 vertebral body for an anterior approach to the spine.…”

Anterior Access to the Cervicothoracic Junction via Partial Sternotomy: A Clinical Series Reporting on Technical Feasibility, Postoperative Morbidity, and Early Surgical Outcome

“…Nonetheless, most surgeons opt for the right-sided sternotomy approach. Besides familiarization from anterior cervical discectomy and fusion (ACDF) approaches, the advantage of a right-sided approach is the avoidance of the aortic arch, which is an anatomic limitation of the anterior exposure of the CTJ [ 8 , 10 , 26 , 27 , 28 ]. In addition, the left recurrent nerve shows a longer course over the aortic arch and is therefore more tangible during the exposure in a left-sided approach [ 29 ].…”

Right transmanubrial approach to the cervicothoracic spine with venous reconstruction

“…To reach the upper thoracic vertebrae, numerous approaches have combined thoracotomy, full sternotomy, or clavicular resection to dissect into the superior mediastinum. 1,2 Although the transmanubrial approach (TMA) provides excellent access and visualization of the anterior thoracic spine, vessels in front of the vertebrae can be obstacles to obtaining a wide working space. 3 To increase the caudal exposure in the present case, the right brachiocephalic vein was temporarily divided and subsequently reconstructed using bovine pericardium.…”