title: Surgical approach to the cervicothoracic junction: can a standard Smith-Robinson approach be utilized?
abstract: METHODS
  Retrospective case series study.
  
  
  OBJECTIVE
  To determine when the standard Smith-Robinson approach can be used successfully to approach the cervicothoracic junction (CTJ).
  
  
  BACKGROUND
  Most of techniques for exposing the anterior CTJ are associated with significant morbidity. To our knowledge, there is no reliable technique, which described to determine when the standard Smith-Robinson approach is adequate and when a more invasive approach, such as a sternal splitting approach, is necessary to approach the CTJ anteriorly.
  
  
  METHODS
  We evaluated the ability of the following technique to preoperatively determine whether a standard Smith-Robinson approach can be used to approach the CTJ: on the lateral plain radiograph, a line was drawn from the intended skin incision site to the top of the manubrium (at the suprasternal notch) to the level of the disc space. If it appeared that this trajectory would allow adequate exposure of the CTJ, then the operation was performed through the standard Smith-Robinson approach. The records and radiographs of all patients who had undergone anterior cervicothoracic arthrodesis to T1 or below were evaluated.
  
  
  RESULTS
  A total of 99 patients who underwent an anterior cervicothoracic fusion using the standard Smith-Robinson approach were identifed. Using the proposed technique, there were no cases in which the planned lowest instrumented vertebra could not be safely reached through the standard Smith-Robinson approach. No procedure was abandoned or converted to a sternotomy approach.
  
  
  CONCLUSIONS
  Our results suggest that if the lowest instrumented vertebra can be seen on a lateral radiograph and a line passing from the intended skin incision site to this level lies on top of the manubrium, a routine Smith-Robinson approach can be used to expose the level. To our knowledge, this is the largest series outlining a simple guideline for approaching the anterior CTJ.
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO, USA. woojinchomd@aol.com
authors.forename: Woojin
authors.initials: W
authors.lastname: Cho
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Buchowski
authors.forename: Yung
authors.initials: Y
authors.lastname: Park
authors.forename: Takeshi
authors.initials: T
authors.lastname: Maeda
authors.forename: Colin E
authors.initials: CE
authors.lastname: Nabb
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008371:Manubrium / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013247:Sternoclavicular Joint / Q000000981:diagnostic imaging / Q000601:surgery; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*