title: Trans-upper-sternal approach to the cervicothoracic junction.
abstract: From August 1999 to February 2006, 11 patients with cervicothoracic lesions (eight males, three females; age range, 17-77 years) were surgically treated using the trans-upper-sternal approach. Combined cervicothoracic incision and upper sternotomy facilitated exposure for tumor resection, partial or subtotal removal of the involved vertebrae, and spinal cord decompression. The spinal column then was stabilized. Neurologic status was assessed using the Frankel classification. Followup for a minimum of 10 months (mean, 31 months; range, 10-56 months) revealed one patient had a chyle leak (50 mL) 1 day after surgery, which resolved after 2 days of drainage. One patient had a transient vocal cord paresis, which recovered within 3 months of surgery. All the patients had improved neurologic function. No nonunions or instrument-related complications developed. Stability of the vertebral column was maintained during followup in all patients. The trans-upper-sternal approach can provide excellent exposure for reconstruction of the cervicothoracic junction. Special care must be taken to avoid injury to the recurrent laryngeal nerve and the thoracic duct.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, 610041, China.
authors.forename: Yi-Lin
authors.initials: YL
authors.lastname: Liu
authors.forename: Ying-Jie
authors.initials: YJ
authors.lastname: Hao
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Yue-Ming
authors.initials: YM
authors.lastname: Song
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Wang