Anterior approach to the cervicothoracic junction without sternotomy: a report of 37 cases.

Abstract

Description of a new anterior approach to the cervicothoracic junction and retrospective study of results. To propose a less invasive anterior approach and report the preliminary results of this technique. Different partial sternotomies with or without associated clavicular resection have been proposed but expose patients to the risk of pseudarthrosis. A less invasive technique should reduce the morbidity of this surgery. From 2000 to 2004, 37 patients were operated between T1 and T4. Whenever possible, access was limited to a left standard cervical approach anterior to the carotid sheath extended caudally. If necessary, partial manubrial resection preserving the sternoclavicular joints was performed to extend the exposure. In the majority of cases, metastatic spinal cord compression was involved. The average duration of surgery was 114 minutes; the average blood loss was 760 mL. For access to the vertebral body of T2, a standard anterior cervical approach alone was always sufficient. For exposure of T3 and T4, median manubrial resection was performed in roughly 1 case out of 2. This was used in every case for T5. There were 4 severe and 3 mild complications. This approach provides satisfactory access to the anterior aspect of the spine down to T5 while preserving the sternoclavicular joints.