J Korean Neurosurg Soc.  2015 Sep;58(3):236-241. 10.3340/jkns.2015.58.3.236.

The Transmanubrial Approach for Cervicothoracic Junction Lesions : Feasibility, Limitations, and Advantages

• Park JH
• Im SB
• Jeong JH
• Hwang SC
• Shin DS
• Kim BT

• KMID: 2191372
• DOI: http://doi.org/10.3340/jkns.2015.58.3.236

Abstract

OBJECTIVE
We report on the technical feasibility and limitations of the transmanubrial approach for cervicothoracic junction (CTJ) lesions and emphasize the advantage of bisecting the upper part of the manubrium in an inverted Y-shape.
METHODS
Thirteen patients who underwent the fourteen transmanubrial approach for various CTJ lesions were enrolled during 2005-2014. For the evaluation of the accessibility for the CTJ lesion, we analyzed the two parallel line defined as a straight line parallel to the inferior and superior plateau of the upper and lower healthy vertebrae, the angle of the two parallel lines and the distance from the sternal notch to lines at the sternum on preoperative magnetic resonance images. Surgical limitations and perspectives, as well as postoperative clinical outcomes were evaluated retrospectively.
RESULTS
The CTJ lesions were six metastases, three primary bone tumors, two herniated discs, and one each of a traumatic dislocation with syrinx formation and tuberculous spondylitis and ossification of the posterior longitudinal ligament. If two parallel lines pass below the sternal notch, the manubriotomy should be inevitably performed. The mean preoperative Visual analogue scale score was 8 (range, 5-10), which improved to 4 (range, 0-6) postoperatively. Seven cases showed an increase in Frankel score postoperatively.
CONCLUSION
The spatial relationship between the sternal notch and the two parallel lines to the lesion was rational to determine the feasibility of manubriotomy. The transmanubrial approach for CTJ lesions can achieve favorable clinical outcomes by providing direct decompression of lesion and effective reconstruction.

Keyword

Manubrium; Thoracic vertebrae; Cervical vertebrae; Sternotomy; Thoracic surgery

MeSH Terms

Cervical Vertebrae
Decompression
Dislocations
Female
Humans
Intervertebral Disc Displacement
Longitudinal Ligaments
Manubrium
Neoplasm Metastasis
Retrospective Studies
Spine
Spondylitis
Sternotomy
Sternum
Thoracic Surgery
Thoracic Vertebrae

Figure

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  Fig. 1 The superior parallel line (SPL); a straight line parallel to the inferior plateau of the superior healthy vertebrae. The inferior parallel line (IPL); straight line parallel to the superior plateau of the inferior healthy vertebrae. The distances between the sternal notch to the SPL and IPL on the axis of the sternum were measured. * : sternal notch, empty arrow head : point of the SPL meets with sternum, filled arrow head : point of the IPL meets with the sternum.

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  Fig. 2 Schematic illustration of anatomical structure around cervicothoracic junction and inverted Y-shape manubriotomy.

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  Fig. 3 Intraoperative photograph. A : bisecting manubrium as inverted Y-shaped with oscillating saw. B : Exposure of innominate vein (arrow) after bisecting manubrium after insertion of strong short retractor. C : Innominate vein (arrow) and other anterior visceral structures.

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  Fig. 4 57 years old man with T2 metastatic tumor. T2 weighted sagittal image shows tumor within T2 vertebral body distorting the cord.

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  Fig. 5 Postoperative MR imaging shows corpectomy and reconstructed states at the T2 level.

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