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Trans-upper-sternal Approach to the Cervicothoracic Junction

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Clinical Orthopaedics and Related Research®

Abstract

From August 1999 to February 2006, 11 patients with cervicothoracic lesions (eight males, three females; age range, 17–77 years) were surgically treated using the trans-upper-sternal approach. Combined cervicothoracic incision and upper sternotomy facilitated exposure for tumor resection, partial or subtotal removal of the involved vertebrae, and spinal cord decompression. The spinal column then was stabilized. Neurologic status was assessed using the Frankel classification. Followup for a minimum of 10 months (mean, 31 months; range, 10–56 months) revealed one patient had a chyle leak (50 mL) 1 day after surgery, which resolved after 2 days of drainage. One patient had a transient vocal cord paresis, which recovered within 3 months of surgery. All the patients had improved neurologic function. No nonunions or instrument-related complications developed. Stability of the vertebral column was maintained during followup in all patients. The trans-upper-sternal approach can provide excellent exposure for reconstruction of the cervicothoracic junction. Special care must be taken to avoid injury to the recurrent laryngeal nerve and the thoracic duct.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Drs. Hong Duan and Jiancheng Zeng, Department of Orthopaedics, West China Hospital, Chengdu, Sichuan province, China, for assistance with radiograph, CT, and MR imaging data.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, 610041, China

    Yi-Lin Liu MD, Tao Li MD & Yue-Ming Song MD

  2. Department of Orthopedic Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China

    Ying-Jie Hao MD & Li-Min Wang MD

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  1. Yi-Lin Liu MD
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  2. Ying-Jie Hao MD
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  3. Tao Li MD
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  4. Yue-Ming Song MD
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  5. Li-Min Wang MD
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Corresponding author

Correspondence to Yue-Ming Song MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.

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Liu, YL., Hao, YJ., Li, T. et al. Trans-upper-sternal Approach to the Cervicothoracic Junction. Clin Orthop Relat Res 467, 2018–2024 (2009). https://doi.org/10.1007/s11999-008-0469-z

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  • DOI: https://doi.org/10.1007/s11999-008-0469-z

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