Cervicothoracic Approach: Manubriotomy and Sternotomy
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.
KeywordsAnterior approach Trans-sternal approach Cervicothoracic junction Vertebral body tumor Metastasis Sternotomy Manubriotomy Corpectomy Reconstruction Fusion Trapdoor Clamshell
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