Abstract
The anterior cervicothoracic spine is a challenging region to approach given the various vascular, osseous, nervous, and articular structures, which prevent adequate exposure. This region is susceptible to lesions ranging from tumors, degenerative disease, infectious processes, and traumatic fractures. Our objective was to critically evaluate the sternotomy approach in spine surgery to give the technical implications of its usage. The safety and efficacy of the transsternal approach are discussed as well as the advantages, disadvantages, indications, and contraindications. The transsternal approach is the most direct access to pathologies in the upper anterior cervicothoracic spine and enables the spine surgeon to gain direct exposure to the cervicothoracic junction for ideal visualization. Anatomical considerations must be kept in mind while performing a sternotomy to prevent complications such as denervation or bleeding. This technique is useful for the armamentarium of spinal surgeons.
Highlights
Anatomical considerations must be kept in mind while performing a sternotomy to prevent complications such as denervation or bleeding. This technique is useful for the armamentarium of spinal surgeons
The anterior cervicothoracic spine is a difficult region of the spine to approach because it contains various vascular, osseous, nervous, and articular structures that prevent adequate exposure [1,2,3]
The anterior transsternal approach is recommended by most surgeons due to the reported advantages of safety and feasibility [2]
Summary
The anterior cervicothoracic spine is a difficult region of the spine to approach because it contains various vascular, osseous, nervous, and articular structures that prevent adequate exposure [1,2,3]. In 1957, Cauchoix and Binet were the first to attempt an anterior approach through a direct median sternotomy for treating cervicothoracic spinal lesions and the surgical modality has continued to evolve [2,4,7]. The anterior transsternal approach is recommended by most surgeons due to the reported advantages of safety and feasibility [2]. This extensive technical report aims to examine current clinical and biomechanical evidence on the sternotomy approach to the spine. We summarize current evidence and discuss pertinent topics for the spinal surgeon considering this evolving approach, including indications, advantages, relevant anatomy, contraindications, and technical considerations
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