Abstract
Anterior approaches to the cervicothoracic junction require precise knowledge of the regional anatomy. In the setting of spinal tumor, complexity is often compounded by distortion of anatomic tissue planes in a debilitated host. The extensive dissection often requires the assistance of a thoracic surgeon. Without sternotomy, access to T2 can be achieved through the use of the low anterior approach, while a modified anterior approach with medial claviculectomy can provide access to T4. Partial manubriotomy or sternotomy can be used in conjunction with the low anterior or modified anterior approaches to facilitate exposure, reconstruction, and instrumentation from C3 to T4 or T5. Complete sternotomy or clamshell extension does not provide access to more caudal levels of the spine, but it may be useful in the setting of spinal tumor with significant intrathoracic involvement.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ames CP, Boriani S, Jandial R. Spine and spinal cord tumors: advanced management and operative techniques. Taylor and Francis Group, LLC: St. Louis; 2014.
Lam FC, Groff MW. An anterior approach to spinal pathology of the upper thoracic spine through a partial manubriotomy. J Neurosurg Spine. 2001;15(5):467–71.
Liu YL, Hao YJ, Li T, Song YM, Wang LM. Trans-upper-sternal approach to the cerivcothoracic junction. Clin Orthop Relat Res. 2009;467(8):2018–24.
Teng H, Hsiang J, Wu C, Wang M, Wei H, Yang X, Xiao J. Surgery in the cervicothoracic junction with an anterior low suprasternal approach alone or combined with manubriotomy and sternotomy: an approach selection method based on the cervicothoracic angle. J Neurosurg Spine. 2009;10:531–42.
Lakshmanan P, Lyons K, Davies PR, Howes JP, Ahuja S. Radiographic assessment of sternal notch level and its significance in approaching the upper thoracic spine. Am J Orthop. 2009;38(4):E71–4.
Cohen ZR, Fourney DR, Gokaslan AL, Walsh GW, Rhines L. Anterior stabilization of the upper thoracic spine via an interaortocaval subinnominate window: case report and description of operative technique. J Spinal Disord Tech. 2004;17:543–8.
Darling GE, McBroom R, Perrin R. Modified anterior approach to the cerivcothoracic junction. Spine (Phila Pa 1976). 1995;20(13):1519–21.
Cauchoix J, Binet JP. Anterior surgical approaches to the spine. Ann R Coll Surg Engl. 1957;21:234–43.
Hodgson AR, Stock FE, Fang HY, Ong GB. Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott’s disease of the spine. Br J Surg. 1960;48:172–8.
Sundaresan N, Shah J, Foley K, Rosen G. An anterior surgical approach to the upper thoracic vertebrae. J Neurosurg. 1984;61:686–90.
Sar C, Hamzaoglu A, Talu U, Domanic U. An anterior approach to the cerivcothoracic junction of the spine (modified osteotomy of manubrium sterni and clavicle). J Spinal Disord. 1999;12(2):102–6.
Shin D, Chae K, Shin D, Kim H. Modified manubriosternal approach to the cerivcothoracic junction. Kor J Spine. 2005;2(1):88–91.
Kurz LT, Pursel SE, Herkowitz HN. Modified anterior approach to the cerivcothoracic junction. Spine. 1991;16(10):542–7.
Kraus DH, Hua J, Burt M. Surgical access to tumors of the cerivcothoracic junction. Head Neck. 1995;17(2):131–6.
Schuchert MJ, McCormick KN, Abbas G, Pennathur A, Landreneau JP, Landreneau JR, et al. Anterior thoracic surgical approaches in the treatment of spinal infections and neoplasms. Ann Thorac Surg. 2014;97:1750–7.
Sattarov KV, Fard SA, Patel AS, Alkadhim M, Avila MJ, Walter CM, et al. Peribrachiocephalic approaches to the anterior cervicothoracic spine. J Clin Neurosci. 2015;22(11):1822–6.
Jung A, Schramm J. How to reduce recurrent laryngeal nerve palsy in anterior cervical spine surgery: a prospective observational study. Neruosurgery. 2010;67(1):10–5.
Derakhshan A, Lubelski D, Steinmetz MP, Corriveau M, Lee S, Pace JR, et al. Thoracic duct injury following cervical spine surgery: a multicenter retrospective review. Global Spine J. 2017;7(1):115S–9S.
Delaney SW, Shi H, Shokrani A, Sinha UK. Management of chyle leak after head and neck surgery: review of current treatment strategies. Int J Otolaryngol. 2017;2017:8362874. https://doi.org/10.1155/2017/8362874.
Civelek E, Karasu A, Cansever T, Hepgul T, Hepgul K, Sabanci A, et al. Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine. Eur Spine J. 2008;17(8):991–5.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Miller, K., Blackmon, S.H., Marco, R.A.W. (2019). Cervicothoracic Approach: Manubriotomy and Sternotomy. In: Sciubba, D. (eds) Spinal Tumor Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-98422-3_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-98422-3_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-98421-6
Online ISBN: 978-3-319-98422-3
eBook Packages: MedicineMedicine (R0)