Anterior Instrumentation of the Cervicothoracic Vertebrae: Approach Based on Clinical and Radiologic Criteria

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Abstract

Study Design.

Anterior instrumentation was performed in 42 cases of cervicothoracic tuberculosis operated using the modified anterior cervical approach.

Objectives.

To define the role of the modified anterior cervical approach in anterior reconstruction and instrumentation of the cervicothoracic vertebrae. To analyze the problems encountered during anterior stabilization in these patients.

Summary of Background Data.

In tuberculosis of cervicothoracic junction, direct anterior visualization is mandatory for optimal decompression of the spinal canal. Anterior reconstruction and stabilization has the advantage of providing immediate stability of vertebral column. The modified anterior cervical approach provides adequate exposure of the upper four thoracic vertebrae. However, radiologic and clinical criteria for anterior instrumentation of the cervicothoracic junction using the modified anterior cervical approach are unclear in literature.

Material and Methods.

A total of 42 patients with tuberculous kyphosis involving the cervicothoracic junction were operated. Based on the association of the sternal notch with the most distal normal vertebra, the patients were divided into 2 surgical groups. The long-neck patients were amenable to anterior instrumentation using the standard supraclavicular approach with a strap-muscle tenotomy. A manubriotomy was mandatory in short-neck patients for optimal visualization and proper placement of the implant.

Results and Conclusion.

Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinct advantage of a stable implant–bone construct anteriorly while preserving the posterior osseo-ligamentous tension band. Detailed preoperative assessment based on clinical and radiologic criteria helps in selection of patient for this procedure. Meticulous intraoperative technique helps to minimize the morbidity and complications associated with this procedure.

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