Anterior Approach to the Cervicothoracic Spine

Abstract

Anterior exposure of the cervicothoracic spine (C7 to T2) presents a significant challenge because of the limited access afforded by anatomical considerations. The junction of the cervical and thoracic spine not only represents the apex of two physiologic curvatures but is also crowded by important neurovascular structures, the trachea and the esophagus at the narrowed thoracic outlet. Median sternotomy as well as partial resection of the manubrium and part of the clavicle on one side have been described but may not be necessary for adequate exposure because of recent improvements in instrumentation and technique. In addition, the increasing familiarity of many surgeons with the anatomy of the area makes less radical approaches more desirable. We present a stepwise approach to the area that may obviate resection of the clavicle or the manubrium, depending on how much exposure can be obtained before proceeding with those steps.