Korean J Neurotrauma.  2019 Apr;15(1):43-49. 10.13004/kjnt.2019.15.e8.

Cervicothoracic Junction Approach using Modified Anterior Approach: J-type Manubriotomy and Low Cervical Incision

• Lee J
• Paeng SH
• Lee WH
• Kim ST
• Lee KS

• KMID: 2444205
• DOI: http://doi.org/10.13004/kjnt.2019.15.e8

Abstract

Spinal surgery of the anterior aspect of the cervicothoracic junction is difficult and has technological challenges because of the kyphotic alignment of the upper thoracic spine. This approach requires knowledge of the cervicothoracic regional anatomy. Surgery in this region is rare because of its indications; despite this rarity, surgeons must be prepared to expose this region. In addition, surgery in this region demands extensive opening of the surgical field and results in severe postoperative pain. Therefore, a less invasive procedure must be considered. Six cases of cervicothoracic lesion operation have been reported. The patients were successfully treated using an anterior modified approach (J-type manubriotomy). Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinct advantage of a stable anterior implant bone construction while preserving the posterior osseo-ligamentous tension band. Moreover, the modified anterior approach (J-type manubriotomy) provides the same exposure of the cervicothoracic junction without a full median sternotomy and avoids injury to subclavian vessels during resection of the clavicle or sternoclavicular junction. Therefore, the anterior cervical approach combined with J-type manubriotomy allows extensive exposure of the cervicothoracic junction and causes less complications. We performed preoperative radiological evaluation to identify the cases in which J-type manubriotomy was necessary.

Keyword

Cervicothoracic; Anterior; Approach; J-type

MeSH Terms

Anatomy, Regional
Clavicle
Humans
Pain, Postoperative
Spine
Sternotomy
Surgeons

Figure

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  FIGURE 1 A simple demonstration was done to a bone cement mold shaped as a sternum. (A-C) A sternum saw was used for vertical bone cutting and oscillating saw was used for horizontal bone cutting. (D) Operative field view after retractors are applied. (E) Post-operative wound.

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  FIGURE 2 The computed tomography (A) revealed T1 burst fracture. The patient was treated with modified transclavicular transmanubriotomy with cervical incision and corpectomy was performed on the first thoracic vertebra and reconstruction was done with fibular allograft and anterior plate from C7 to T2 and the left clavicle was reapproximated (red circle) (B).

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  FIGURE 3 He had a traffic accident. His ASIA score was A. Initial CT showed stable vertebral body fracture in T1 (A). Sagittal T2 weighted MRI showed no cord signal change in cervicothoracic level (B). After paraparesis, CT and 3-dimensional CT revealed anterior dislocation and translation C7 on T1 and kyphotic angulation was observed (C). Sagittal T2 weighted MRI revealed diffuse cord signal change in C7/T1 area due to dislocation (blue arrow) (D).Postoperative CT showed T1 median corpectomy and reconstruction with titanium mesh andanterior plate from C7 to T1 via modified anterior transmaubriotomy (E).CT: computed tomography.

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  FIGURE 4 Intraoperative surgical views of patient.

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