title: Anterior surgical approaches to the cervicothoracic junction: when to use the manubriotomy?
abstract: BACKGROUND
  The cervicothoracic junction (CTJ) is always a difficult area for anterior approaches. Among them, low anterior cervical approach alone or combined with manubriotomy is the most frequently used.
  
  
  OBJECTIVE
  To study the need of manubriotomy.
  
  
  METHODS
  Comparison of last guidelines proposed in literature.
  
  
  METHODS
  Seven patients treated between March 2010 and March 2011.
  
  
  METHODS
  All the patients were scanned on with computed tomography and magnetic resonance of the spinal column before surgery. Measurements by Teng and Karikari were applied in all the cases. An illustrative case is showed.
  
  
  RESULTS
  The anterior approaches to the CTJ are reviewed. The most recent guidelines by Teng and Karikari are easy to apply and careful. The results obtained were the same in all the cases with good outcome.
  
  
  CONCLUSIONS
  Manubriotomy permits a good exposure of the CTJ area with a low rate of complications. Either Teng and Karikari's guidelines can be used to estabilish the need of manubriotomy.
authors.affiliation: Department of Neurosurgery, "Sapienza" University, Viale Del Policlinico 115, 00161 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Tarantino
authors.forename: Pasquale
authors.initials: P
authors.lastname: Donnarumma
authors.forename: Daniele
authors.initials: D
authors.lastname: Marruzzo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Landi
authors.forename: Tiziano
authors.initials: T
authors.lastname: De Giacomo
authors.forename: Roberto
authors.initials: R
authors.lastname: Delfini
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008371:Manubrium / Q000601:surgery*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010027:Osteotomy / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery*
keywords: Anterior approaches; Cervicothoracic junction; Manubriotomy