Abstract
To determine the location of left brachiocephalic vein (BCV) and tracheal bifurcation (TB) relative to the vertebral levels, and to ascertain the accessibility of three different corridors (C1: between the esophagus and trachea medially and the carotid sheath laterally, C2: between the right BCV and the brachiocephalic artery, and C3: between the ascending aorta and superior vena cava) for preoperative planning. From August 2008 to April 2009, normal chest CT scans of 150 subjects ranging in age from 18 to 78 years were selected. According to our definition, of the 150 studies, 132 T2 vertebral bodies (VBs) could be accessed through C1 (88.0%), 100 T3 VBs could be reached through C2 (66.7%), and 110 T4 VBs could be exposed through C3 (73.3%). The results suggest that the surgical accessibility of three different corridors is different and we conclude that T2, T3, and T4 are, respectively, readily accessible through C1, C2, and C3.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
An HS, Wise JJ, Xu R (1999) Anatomy of the cervicothoracic junction: a study of cadaveric dissection, cryomicrotomy, and magnetic resonance imaging. J Spinal Disord 12:519–525
Birch R, Bonney G, Marshall RW (1990) A surgical approach to the cervicothoracic spine. J Bone Jt Surg Br 72:904–907
Boockvar JA, Philips MF, Telfeian AE et al (2001) Results and risk factors for anterior cervicothoracic junction surgery. J Neurosurg 94:12–17
Cauchoix J, Binet JP (1957) Anterior surgical approaches to the spine. Ann R Coll Surg Engl 21:237–243
Charles R, Govender S (1989) Anterior approach to the upper thoracic vertebrae. J Bone Jt Surg Br 71:81–84
Cohen ZR, Fourney DR, Gokaslan ZL et al (2004) Anterior stabilization of the upper thoracic spine via an “Interaortocaval Subinnominate Window”: case report and description of operative technique. J Spinal Disord Tech 17:543–548
Ebraheim NA, Lu J, Skie M et al (1997) Vulnerability of the recurrent laryngeal nerve in the anterior approach to the lower cervical spine. Spine 22:2664–2667
Fraser JF, Diwan AD, Peterson M et al (2002) Preoperative magnetic resonance imaging screening for a surgical decision regarding the approach for anterior spine fusion at the cervicothoracic junction. Spine 27:675–681
Gerlis LM, Ho SY (1989) Anomalous subaortic position of the brachiocephalic (innominate) vein: a review of published reports and report of three new cases. Br Heart J 61:540–545
Gieger M, Roth PA, Wu JK (1995) The anterior cervical approach to the cervicothoracic junction. Neurosurgery 37:704–709
Kaya RA, Türkmenoğlu ON, Koç ON et al (2006) A perspective for the selection of surgical approaches in patients with upper thoracic and cervicothoracic junction instabilities. Surg Neurol 65:454–463
Kurz LT, Pursel SE, Herkowitz HN (1991) Modified anterior approach to the cervicothoracic junction. Spine 16:S542–S547
Lehman RM, Grunwerg B, Hall T (1997) Anterior approach to the cervicothoracic junction: an anatomic dissection. J Spinal Disord 10:33–39
Lesoin F, Thomas CE 3rd, Autricque A et al (1986) A transsternal biclavicular approach to the upper anterior thoracic spine. Surg Neurol 26:253–256
Liu YL, Hao YJ, Li T et al (2009) Trans-upper-sternal approach to the cervicothoracic junction. Clin Orthop Relat Res 467:2018–2024
Luk KD, Cheung KM, Leong JC (2002) Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. A report of five cases. J Bone Jt Surg Am 84-A:1013–1017
Miscusi M, Bellitti A, Polli FM (2005) Surgical approaches to the cervico-thoracic junction. J Neurosurg Sci 49:49–57
Morhy Borges Leal S, Andrade JL, de Souza M et al (2002) Anomalous subaortic course of the left brachiocephalic (innominate) vein: echocardiographic diagnosis and report of an unusual association. Cardiol Young 12:159–163
Netterville JL, Koriwchak MJ, Winkle M et al (1996) Vocal fold paralysis following the anterior approach to the cervical spine. Ann Otol Rhinol Laryngol 105:85–91
Pointillart V, Aurouer N, Gangnet N et al (2007) Anterior approach to the cervicothoracic junction without sternotomy: a report of 37 cases. Spine 32:2875–2879
Prabhakar MM, Thakker T (2006) Anterior decompression for cervicothoracic pathology: a study of 14 patients. J Spinal Cord Med 29:163–166
Sharan AD, Przybylski GJ, Tartaglino L (2000) Approaching the upper thoracic vertebrae without sternotomy or thoracotomy: a radiographic analysis with clinical application. Spine 25:910–916
Teng H, Hsiang J, Wu C et al (2009) Surgery in the cervicothoracic junction with an anterior low suprasternal approach alone or combined with manubriotomy and sternotomy: an approach selection method based on the cervicothoracic angle. J Neurosurg Spine 10:531–542
Xiao ZM, Zhan XL, Gong de F et al (2007) Surgical management for upper thoracic spine tumors by a transmanubrium approach and a new space. Eur Spine J 16:439–444
Xu R, Grabow R, Ebraheim NA et al (2000) Anatomic considerations of a modified anterior approach to the cervicothoracic junction. Am J Orthop 29:37–40
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Huang, Yx., Ni, Wf., Wang, S. et al. Anterior approaches to the cervicothoracic junction: a study on the surgical accessibility of three different corridors based on the CT images. Eur Spine J 19, 1936–1941 (2010). https://doi.org/10.1007/s00586-010-1478-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-010-1478-7