title: Simple method for determining the need for sternotomy/manubriotomy with the anterior approach to the cervicothoracic junction.
abstract: OBJECTIVE
  Frequently, the cervicothoracic junction can be reached through a simple anterior approach. In some cases, access to this region requires a much more aggressive surgical intervention, such as manubriotomy or sternotomy. Information regarding the need for such interventions is particularly useful to have preoperatively to guide surgical planning as well as discussions regarding surgical risks and expected morbidities. Whereas methods utilizing magnetic resonance imaging have been proposed for determining the lowest level that can be accessed through a simple low cervical approach, we describe a simple technique using sagittal computed tomographic imaging. Our technique does not require any complex geometry and has given us very consistent results.
  
  
  METHODS
  Computed tomographic sagittal reconstruction of the cervical and upper thoracic spine that includes the entire sternum is obtained. The lowest accessible disc space is determined by a straight line passing through and parallel to the disc space that also passes above the manubrium (the intervertebral disc line).
  
  
  RESULTS
  Sagittal computed tomographic reconstructions obtained from 50 adult patients were reviewed, and the lowest disc space accessible from an anterior low cervical approach was determined. The most common accessible level was T1-T2 (23 patients), followed by C7-T1 (13 patients), T2-T3 (10 patients), and C6-C7 (4 patients). A 35-year-old man with T2-T3 compression fractures with kyphotic deformity was treated with T2 and T3 vertebrectomies and T1-T4 fusion through an anterior approach.
  
  
  CONCLUSIONS
  We propose a simple and consistent method for determining the need for manubriotomy or sternotomy for anterior approaches to the cervicothoracic junction.
authors.affiliation: Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
authors.forename: Ciaran J
authors.initials: CJ
authors.lastname: Powers
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry / Q000379:methods; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008371:Manubrium / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D056346:Sternotomy / Q000379:methods* / Q000592:standards; D013249:Sternum / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult