Modified Anterior Approach to the Cervicothoracic Junction

Study Design This study reports the experience with four patients regarding a modified anterior approach to the cervicothoracic junction. Objectives This technique was evaluated with respect to extent of exposure, ease of technique, and postoperative morbidity. Summary of Background Data Previously reported anterior approaches to the cervicothoracic junction have described either full stemotomy resection of the left sternoclavicular junction or osteotomy of the clavicle. A simplified approach was chosen using a partial sternotomy, which has not been described previously for approaches to the spine. Methods Four patients with metastatic disease, In the region of the cervicothoracic junction, required decompression and stabilization for palliation of symptoms. An anterior approach was required for decompression. A standard cervical approach was combined with a partial median sternotomy and transverse osteotomy through the synostosls between the manubrium and body of the sternum. In three patients, the left innominate vein was divided. Decompression and anterior stabilization were followed by posterior stabilization at an interval of 4 to 7 days. Results This procedure was simple to perform, requiring little additional operative time for opening or closure. It provided excellent exposure from C3-T4. There was no associated morbidity related to the division of the manubrium or Innominate vein. Conclusion Partial sternotomy combined with a standard cervical incision provides excellent exposure to the cervicothoracic junction from C3-T4. It is technically simple to perform and avoids the risk of injury to subclavian vessels inherent in resection of the clavicle or sternoclavicular junction. There is no additional morbidity associated with this approach.