title: Cervicosternotomy as an anterior approach to the upper thoracic and cervicothoracic spinal junction.
abstract: OBJECTIVE
  The cervicothoracic junction is always a difficult area to approach. When operating on this specific area (for tumor or trauma), the aim is generally to decompress and stabilize the spine. The authors describe an improved median sternotomy method for reaching the anterior aspect of the spine down to T-5.
  
  
  METHODS
  Seven patients with a mean age of 40 years (range 17-68 years) were included in this study. The vertebral lesion was due to trauma in 4 cases and tumor in the other 3. A single vertebral body was involved in 2 cases, 2 in 3 cases, and 3 in 2 cases. The vertebra most often involved was T-3 (6 cases), although T-4 was involved in 2 cases, T-5 in 2 cases, and T-1 and T-2 in 1 case each. All patients underwent the same preoperative workup: CT scanning, MR imaging, and CT angiography of the aortic arch.
  
  
  RESULTS
  The median sternotomy made it possible to effectively decompress and stabilize the spinal cord. An anterior screw plate was used in 5 cases. The plate extended from T-2 to T-5 in 3 cases, from T-2 to T-4 in 2 cases, and from C-7 to T-4 in 1 case. The mean duration of surgery was 195 minutes (range 180-240 minutes). No neurological deterioration occurred. The mean hospital stay was 8 days (range 6-15 days). In 2 cases (28.6%), recurrent left nerve palsy was observed postoperatively; the palsy was transient in both of these cases, and full recovery occurred within 3 months. The mean follow-up among this series of patients was 29 months (range 22-38 months).
  
  
  CONCLUSIONS
  The median sternotomy provided a good means of reaching the upper thoracic spine (T2-5) and cervicothoracic junction. It enables surgeons to decompress the spinal cord and stabilize the spine.
authors.affiliation: Department of Neurosurgery, Centre Hospitalier Régional Universitaire, Timone, Marseille, France. sfuentes@ap-hm.fr
authors.forename: Stéphane
authors.initials: S
authors.lastname: Fuentes
authors.forename: Sergueï
authors.initials: S
authors.lastname: Malikov
authors.forename: Benjamin
authors.initials: B
authors.lastname: Blondel
authors.forename: Philippe
authors.initials: P
authors.lastname: Métellus
authors.forename: Henry
authors.initials: H
authors.lastname: Dufour
authors.forename: François
authors.initials: F
authors.lastname: Grisoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods; D013119:Spinal Cord Injuries / Q000473:pathology / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery*; D056346:Sternotomy / Q000379:methods*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome