MODIFIED ANTERIOR APPROACH TO THE CERVICOTHORACIC JUNCTION

Study Design. This study reports the experience with four patients reg arding a modified anterior approach to the cervicothoracic junction. O bjectives. This technique was evaluated with respect to extent of expo sure, ease of technique, and postoperative morbidity. Summary of Backg round Data. Previously reported anterior approaches to the cervicothor acic junction have described either full sternotomy resection of the l eft sternoclavicular junction or osteotomy of the clavicle, A simplifi ed approach was chosen using a partial sternotomy, which has not been described previously for approaches to the spine. Methods. Four patien ts with metastatic disease, in the region of the cervicothoracic junct ion, required decompression and stabilization for palliation of sympto ms. An anterior approach was required for decompression. A standard ce rvical approach was combined with a partial median sternotomy and tran sverse osteotomy through the synostosis between the manubrium and body of the sternum. In three patients, the left innominate vein was divid ed. Decompression and anterior stabilization were followed by posterio r 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 o r innominate vein. Conclusion. Partial sternotomy combined with a stan dard cervical incision provides excellent exposure to the cervicothora cic junction from C3-T4. It is technically simple to perform and avoid s the risk of injury to subclavian vessels inherent in resection of th e clavicle or sternoclavicular junction. There is no additional morbid ity associated with this approach.