title: A novel approach to the upper anterior thoracic spine: a cadaveric feasibility study.
abstract: OBJECTIVE
  Surgical approaches to the upper anterior thoracic spine can be a challenge. Various techniques such as transsternal routes have been employed but access to the midthoracic vertebrae is limited due to the position of the heart and great vessels. In the present study the authors' goal was to evaluate in cadavers a novel approach to the upper anterior thoracic spine.
  
  
  METHODS
  In 12 adult cadavers the majority of the left first rib was removed following infraclavicular transection of the attachment of the anterior and middle scalene muscles from this bone. Inferior retraction of the parietal pleura and lung was performed and dissection was carried out inferior to the left subclavian artery and superior and posterior to the aorta, to the anterior aspect of the upper thoracic spine.
  
  
  RESULTS
  The aforementioned approach and surgical corridor allowed a good access to the anterior aspect of the upper thoracic vertebrae and caudally to the inferior aspect of T-4 vertebral body in all cadavers. No obvious neurovascular injury was identified in any specimen.
  
  
  CONCLUSIONS
  To the authors' knowledge, the method described herein has not been previously reported. Based on their cadaveric study, they believe such an approach can be used in the patients with pathology in this region of the thoracic spine. Surgical series are now needed to confirm our findings.
authors.affiliation: Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA. rstubbs@uab.edu
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Marios
authors.initials: M
authors.lastname: Loukas
authors.forename: James D
authors.initials: JD
authors.lastname: Callahan
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D013904:Thoracic Vertebrae / Q000098:blood supply / Q000601:surgery*