title: Sternal split approach to the cervicothoracic junction in children.
abstract: METHODS
  We present a descriptive case series outlining the surgical technique and outcome in six patients managed with a combined anterior neck and sternal splitting approach.
  
  
  OBJECTIVE
  To describe a surgical approach used in the management of severe cervicothoracic kyphosis and/or scoliosis in pediatric patients.
  
  
  BACKGROUND
  There are few reports in the literature that address the problem of accessing multileveled spinal deformities around the cervicothoracic junction requiring stabilization in the pediatric population.
  
  
  METHODS
  A detailed chart and radiographic review was completed of six consecutive patients managed at our center with a combined anterior neck and sternal splitting approach. The indications, surgical technique, and outcome are reviewed for each case. This technique was employed in 6 pediatric patients, aged 3-15 years, at the authors' institution. Diagnoses included Klippel-Feil Syndrome (2 patients), Proteus Syndrome, Larsen Syndrome, and neurofibromatosis type I (2 patients). All patients had severe cervicothoracic kyphosis requiring surgical instrumentation. This technique allowed surgical access from C5-T6.
  
  
  RESULTS
  This approach was invaluable in gaining access to the cervicothoracic junction to address complex spinal deformities in pediatric patients. In one patient, a separate thoracotomy was performed to access the lower thoracic spine. The only significant complication related to the approach was recurrent laryngeal nerve palsy experienced by one patient. This approach allowed stabilization of severe scoliotic and/or kyphotic deformities to impede curve progression.
  
  
  CONCLUSIONS
  This approach was invaluable in gaining multileveled access to the cervicothoracic junction to address complex spinal deformities in pediatric patients.
authors.affiliation: Department of Orthopaedics, British Columbia's Children's Hospital, Vancouver, Canada. kmulpuri@cw.bc.ca
authors.forename: Kishore
authors.initials: K
authors.lastname: Mulpuri
authors.forename: Jacques G
authors.initials: JG
authors.lastname: LeBlanc
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Reilly
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Poskitt
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Choit
authors.forename: Vic
authors.initials: V
authors.lastname: Sahajpal
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Tredwell
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D012600:Scoliosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013249:Sternum / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*