“Trap door” exposure of the cervicothoracic junction

1994 ◽  
Vol 80 (2) ◽  
pp. 338-341 ◽  
Author(s):  
Jules M. Nazzaro ◽  
Ehud Arbit ◽  
Michael Burt
Keyword(s):  
Anterior Approach ◽  
Median Sternotomy ◽  
Sternoclavicular Joint ◽  
Sternocleidomastoid Muscle ◽  
Cervicothoracic Junction ◽  
Content Type ◽  
Upper Thoracic Spine ◽  
Trap Door ◽  
Anterolateral Thoracotomy ◽  
Upper Thoracic

✓ This report describes a “trap door” exposure of the cervicothoracic junction. The method combines a standard anterior approach to the spine along the medial border of the sternocleidomastoid muscle with both a partial median sternotomy and an anterolateral thoracotomy. Transection of the clavicle is not required and the sternoclavicular joint is preserved. With this method, all important ventral paravertebral vessels, nerves, and associated soft tissue are fully identified and readily mobilized as needed. The method provides full bilateral anterior exposure from the C-4 through at least the T-3 vertebral levels, as well as unilateral anterolateral access to the upper thoracic spine.

A transsternoclavicular approach for the anterior decompression and fusion of the upper thoracic spine

2005 ◽  
Vol 2 (2) ◽  
pp. 226-229 ◽  
Author(s):  
Mutsuhiro Tamura ◽  
Masashi Saito ◽  
Masafumi Machida ◽  
Keiichi Shibasaki
Keyword(s):  
Thoracic Spine ◽  
Anterior Approach ◽  
Anterior Decompression ◽  
Thoracic Region ◽  
Anatomical Structures ◽  
Content Type ◽  
Upper Thoracic Spine ◽  
Upper Thoracic ◽  
Anterior Decompression And Fusion ◽  
Fine Print

✓ The anterior approach is commonly used to reach the upper thoracic region to achieve decompression and stabilization; however, upper thoracic lesions are difficult to treat because of the regional anatomical structures, and this approach is associated with risks of complication. The authors evaluated the advantages of using a transsternoclavicular approach to aid in treating upper thoracic lesions. The procedure and surgery-related outcomes are discussed.

An anterior approach to spinal pathology of the upper thoracic spine through a partial manubriotomy

2011 ◽  
Vol 15 (5) ◽  
pp. 467-471 ◽  
Author(s):  
Fred C. Lam ◽  
Michael W. Groff
Keyword(s):  
Thoracic Spine ◽  
Anterior Approach ◽  
Surgical Pathology ◽  
Anterior Decompression ◽  
Upper Thoracic Spine ◽  
Perioperative Morbidity ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Upper Thoracic

Surgical pathology in the region of the upper thoracic spine (T1–4) is uncommon compared with other regions of the spine. Often times posterior and posterolateral approaches can be used, but formal anterior decompression often requires a low anterior cervical approach combined with a sternotomy, which yields significant perioperative morbidity. The authors describe a modified low anterior cervical dissection combined with a partial manubriotomy that they have used to successfully access and decompress anterior pathology of the upper thoracic spine. Their modified approach spares the sternoclavicular joints and leaves the sternum intact, decreasing the morbidity associated with these added procedures.

Cervicosternotomy as an anterior approach to the upper thoracic and cervicothoracic spinal junction

2010 ◽  
Vol 12 (2) ◽  
pp. 160-164 ◽  
Author(s):  
Stéphane Fuentes ◽  
Sergueï Malikov ◽  
Benjamin Blondel ◽  
Philippe Métellus ◽  
Henry Dufour ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Median Sternotomy ◽  
Specific Area ◽  
Ct Scanning ◽  
Cervicothoracic Junction ◽  
Duration Of Surgery ◽  
The Mean ◽  
Difficult Area ◽  
Upper Thoracic

Object The cervicothoracic junction is always a difficult area to approach. When operating on this specific area (for tumor or trauma), the aim is generally to decompress and stabilize the spine. The authors describe an improved median sternotomy method for reaching the anterior aspect of the spine down to T-5. Methods Seven patients with a mean age of 40 years (range 17–68 years) were included in this study. The vertebral lesion was due to trauma in 4 cases and tumor in the other 3. A single vertebral body was involved in 2 cases, 2 in 3 cases, and 3 in 2 cases. The vertebra most often involved was T-3 (6 cases), although T-4 was involved in 2 cases, T-5 in 2 cases, and T-1 and T-2 in 1 case each. All patients underwent the same preoperative workup: CT scanning, MR imaging, and CT angiography of the aortic arch. Results The median sternotomy made it possible to effectively decompress and stabilize the spinal cord. An anterior screw plate was used in 5 cases. The plate extended from T-2 to T-5 in 3 cases, from T-2 to T-4 in 2 cases, and from C-7 to T-4 in 1 case. The mean duration of surgery was 195 minutes (range 180–240 minutes). No neurological deterioration occurred. The mean hospital stay was 8 days (range 6–15 days). In 2 cases (28.6%), recurrent left nerve palsy was observed postoperatively; the palsy was transient in both of these cases, and full recovery occurred within 3 months. The mean follow-up among this series of patients was 29 months (range 22–38 months). Conclusions The median sternotomy provided a good means of reaching the upper thoracic spine (T2–5) and cervicothoracic junction. It enables surgeons to decompress the spinal cord and stabilize the spine.

Results and risk factors for anterior cervicothoracic junction surgery

2001 ◽  
Vol 94 (1) ◽  
pp. 12-17 ◽  
Author(s):  
John A. Boockvar ◽  
Matthew F. Philips ◽  
Albert E. Telfeian ◽  
Donald M. O'Rourke ◽  
Paul J. Marcotte
Keyword(s):  
Risk Factors ◽  
Anterior Approach ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Significant Risk ◽  
Cervicothoracic Junction ◽  
Content Type ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Four Levels ◽  
Fine Print

Object. Stabilization of the cervicothoracic junction (CTJ) requires special attention to the operative approach and biomechanical requirements of the fixation construct. In this study the authors assess the morbidity associated with the anterior approach to the CTJ and define risks that may lead to construct failure after anterior CTJ surgery. Methods. Data obtained for 14 patients (six men and eight women, mean age 50.1 years) who underwent surgical stabilization of the CTJ via an anterior cervical approach were retrospectively reviewed to assess the anterior approach—related morbidity and the risks of construct failure. The mean follow-up period was 21.1 months. Four patients (29%) had previously undergone CTJ surgery; in 11 patients (64%) more than one motion segment was involved (two levels, six patients; three levels, four patients; four levels, one patient); allograft was placed in three (21%) of 14 graft sites; and anterior plates were used for reconstruction augmentation in eight patients (57%). Postoperatively all patients improved, although four patients had residual deficits or pain. Graft/plate failure, requiring surgical revision and/or halo placement, occurred in five patients (36%). One patient experienced transient recurrent laryngeal nerve palsy. Postoperatively, the authors classified patients into one of two groups: those in whom surgery was successful (nine cases) and those in whom it had failed (five cases). Analysis of the characteristics of these two groups revealed that male sex (p < 0.0365), multiple levels of involvement (p < 0.0378), and the use of allograft as compared with autograft (p < 0.0088) were significant risk factors for construct failure. Prior CTJ surgery (p < 0.053) tended to be associated with graft failure. Conclusions: Findings of this study, in the setting of these factors, indicate that anterior reconstruction alone may not meet the biomechanical needs of this spinal region and that supplementary fixation may be considered to augment stabilization for fusion success.

Spontaneous intracranial hypotension associated with transdural thoracic osteophyte reversed by primary dural repair

2005 ◽  
Vol 2 (5) ◽  
pp. 614-618 ◽  
Author(s):  
Devin K. Binder ◽  
Vahé Sarkissian ◽  
William P. Dillon ◽  
Philip R. Weinstein
Keyword(s):  
Intracranial Hypotension ◽  
Surgical Intervention ◽  
Median Sternotomy ◽  
Spontaneous Intracranial Hypotension ◽  
Imaging Features ◽  
Dural Repair ◽  
Content Type ◽  
Csf Leakage ◽  
Upper Thoracic ◽  
Csf Leaks

✓ Spontaneous intracranial hypotension (SIH) is an increasingly recognized syndrome associated with a specific set of clinical and imaging findings; however, determining the site of spinal cerebrospinal fluid (CSF) leakage in these patients is often difficult, and indications for surgical intervention need to be better defined. The authors report on a 55-year-old woman who presented with posture-related headache, disorientation, and memory impairment. Imaging features were consistent with SIH. Computerized tomography myelography demonstrated a large T2–3 anterior transdural osteophyte associated with a CSF fistula. After an unsuccessful trial of conservative therapy, the patient underwent median sternotomy, T2–3 discectomy and removal of osteophyte, which allowed adequate exposure for primary dural repair. Postoperatively, there was immediate and prolonged resolution of all of her symptoms. This case of SIH was caused by transdural penetration by an anterior osteophyte and CSF leakage in the upper thoracic spine, which was treated effectively by anterior exposure and primary dural repair. Aggressive surgical intervention may be required to treat upper thoracic CSF leaks refractory to other measures.

scholarly journals Treatment of Anterior Approach to Upper Thoracic Spine Using Total Sternum Splitting

2012 ◽  
Vol 61 (3) ◽  
pp. 513-517
Author(s):  
Shogo Tahata ◽  
Koji Akasaki ◽  
Taka-aki Sagara ◽  
Yosuke Kawatani ◽  
Hiroyuki Watanabe ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Anterior Approach ◽  
Upper Thoracic Spine ◽  
Upper Thoracic

Eosinophilic granuloma of the cervicothoracic junction

1989 ◽  
Vol 71 (6) ◽  
pp. 942-944 ◽  
Author(s):  
Thomas A. Sweasey ◽  
Robert C. Dauser
Keyword(s):  
Anterior Approach ◽  
Eosinophilic Granuloma ◽  
Cervicothoracic Junction ◽  
Content Type ◽  
Gain Access ◽  
Fine Print

✓ A case is reported of eosinophilic granuloma at the cervicothoracic junction presenting with profound quadriparesis preoperatively. The patient underwent excision via an anterior approach, with splitting of the sternum to gain access to the T-1 vertebra. Postoperatively, he has had an excellent return of function.

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