The Anterior Cervical Approach to the Cervicothoracic Junction

Gieger, Michael; Roth, Patrick; Wu, Julian K.

doi:10.1227/00006123-199510000-00014

Cited by 53 publications

(19 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite these limitations, the authors of several small case series have described a suprasternal approach to the upper thoracic spine. 3,[5][6][7] The anatomical constraints of this exposure have been elegantly described in studies by Gieger, et al, and Comey, et al These authors emphasized the importance of thorough knowledge of the regional anatomy, especially of the recurrent laryngeal nerves and thoracic ducts. 5,6 Therefore a left-sided approach was preferentially used whenever possible.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anterior cervicothoracic junction corpectomy and plate fixation without sternotomy

Resnick¹

2002

FOC

View full text Add to dashboard Cite

Object Exposure of the lower cervical and upper thoracic spinal regions through a cervical incision without sternotomy has been described in cases of anterior decompression and methylmethacrylate vertebral body reconstruction. The use of anterior instrumentation and structural bone grafts in this procedure has not been well described. Methods Twenty-one patients underwent anterior cervicothoracic decompression, fusion, and fixation via a low cervical approach. Eight of these patients underwent lower cervical or upper thoracic corpectomy (C7–T4) through the cervical incision. The decompressive procedure was followed by placement of an allograft bone strut and an anterior locking plate system. No patient developed new neurological deficit related to the spinal cord or exiting nerve roots. Three of four patients with preoperative neurological deficits improved dramatically. Two patients developed recurrent laryngeal nerve palsy, of which one was permanent. There was one case of instrumentation-related failure, and two patients developed a superficial wound infection related to a posterior incision made as part of a 360° fusion. Patients were followed for a mean of 18.5 months (range 2–30 months). Two patients died (of metastatic cancer, and a motor vehicle accident, respectively) during the follow-up period. Conclusions Anterior decompression, fusion, and fixation is feasible via a cervical incision. This procedural approach spares the patient the morbidity associated with sternotomy or the lateral extracavitary approach. A thorough preoperative assessment of mediastinal anatomy is essential for the safe execution of these procedures.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Geiger, et al, 6 and Comey, et al, 5 have discussed the need to review preoperative imaging studies to determine the feasibility of the approach. Sharan and colleagues 12 conducted a review of 103 patients who underwent MR imaging of the cervicothoracic junction.…”

Section: Discussionmentioning

confidence: 99%

Anterior cervicothoracic junction corpectomy and plate fixation without sternotomy

Resnick¹

2002

FOC

View full text Add to dashboard Cite

show abstract

“…Because of the deep location of vertebral bodies due to the kyphosis of the upper thoracic spine and the presence of neurovascular and osseous obstacles over the operative field in this region, surgical access is often limited [15,17,22,25]. As for neurovascular obstacles, such as the brachiocephalic veins, thoracic duct, and recurrent laryngeal nerves, they can be easily injured which might lead to significant complications [10,12,19,25]. The best way is to bypass them and to reach the spine through neurovascular space.…”

Section: Discussionmentioning

confidence: 99%

Mini-open anterior approach to the cervicothoracic junction: a cadaveric study

et al. 2013

View full text Add to dashboard Cite

Purpose To investigate the feasibility of mini-open anterior approach to the cervicothoracic junction (CTJ) in cadaveric specimens. Methods Four adult fresh-frozen cadaveric specimens were used for this study. On the cadaveric specimen, an osteotomy window was made in manubrium sterni to remove the bony obstacle. To bypass the vital vascular and neural structures over the operative field, we used the surgical corridor which was located medially by the brachiocephalic artery and laterally by the right brachiocephalic vein, or in combination with another surgical corridor between the ascending aorta and the superior vena cava. And we used a special self-retaining retractor system and an endoscope to facilitate the procedures. Results Surgical procedures performed on the four freshfrozen cadaveric specimens to expose the CTJ through mini-open anterior approach were successful. The anterior surface of C6-T5 could be exposed, allowing complete decompression and application of locking plate and screws. The most caudal accessible vertebral body was T5 vertebral body in our study. Conclusion It is feasible to expose the CTJ through this mini-open anterior approach.

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

The Anterior Cervical Approach to the Cervicothoracic Junction

Cited by 53 publications

References 10 publications

Anterior cervicothoracic junction corpectomy and plate fixation without sternotomy

Anterior cervicothoracic junction corpectomy and plate fixation without sternotomy

Mini-open anterior approach to the cervicothoracic junction: a cadaveric study

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

Contact Info

Product

Resources

About