title: A perspective for the selection of surgical approaches in patients with upper thoracic and cervicothoracic junction instabilities.
abstract: OBJECTIVE
  To reach the upper thoracic vertebrae, a number of extensive approaches have been proposed. The purpose of this study is to provide a clear perspective for the selection of surgical approaches in patients who undergo vertebral body resection, reconstruction, and stabilization for upper thoracic and cervicothoracic junction instabilities.
  
  
  METHODS
  Seventeen patients with upper thoracic or cervicothoracic junction (C7-T6) instability underwent surgery between January 1999 and May 2004. All patients presented with pain and/or neurological deficits. The causes of instabilities were 10 traumas and 7 pathological fractures. The approach chosen was primarily dictated by 3 factors including (1) type of injury, (2) level of lesion, and (3) time of admission. Ventral surgical approach was performed to all pathological and traumatic fractures causing anterior spinal cord compression. Level of lesion determined the selection of the type of ventral surgical approach, namely, supramanubrial, transmanubrial, or lateral transthoracic. On the other hand, combined (anterior and posterior) approach was performed to all late admitted trauma patients.
  
  
  RESULTS
  Twelve anterior, 2 combined (anterior and posterior), and 3 posterior approaches were performed in this study. Anterior approaches included 3 transmanubrial, 5 upper lateral transthoracic, and 4 supramanubrial cervical dissection procedures for decompression, fusion, and plate-screw fixation depending on the levels of the lesion. The mean follow-up period was 18 months, ranging from 10 to 58 months. Nonunion or instrument-related complications were not observed. The postoperative neurological conditions were statistically significantly better than the preoperative ones (P = .003).
  
  
  CONCLUSIONS
  Consideration of the type of injury, level of lesion, and time of admission can provide a perspective for the selection of side of surgical approach for this transitional part of the spinal column. This study also suggests that supramanubrial cervical approach achieves sufficient exposure up to T2, transmanubrial approach for T3, and lateral transthoracic approach below T3.
authors.affiliation: Sişili Etfal State Hospital, Clinic of Neurosurgery, Istanbul, Turkey. alpkaya67@yahoo.com
authors.forename: Ramazan Alper
authors.initials: RA
authors.lastname: Kaya
authors.forename: Osman Nuri
authors.initials: ON
authors.lastname: Türkmenoğlu
authors.forename: Omer Nadir
authors.initials: ON
authors.lastname: Koç
authors.forename: Haci Ali
authors.initials: HA
authors.lastname: Genç
authors.forename: Halit
authors.initials: H
authors.lastname: Cavuşoğlu
authors.forename: Ibrahim Mustafa
authors.initials: IM
authors.lastname: Ziyal
authors.forename: Yunus
authors.initials: Y
authors.lastname: Aydin
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*