Article Abstract

The Manubriotomy is a safe option for the anterior approach to the cervico-thoracic junction

Authors: Pasquale Donnarumma, Lorenzo Nigro, Roberto Tarantino, Tiziano De Giacomo, Roberto Delfini


The cervicothoracic junction (CTJ) is defined as the area extending from vertebral segments C7 to T4. Because most pathological processes occur in the anterior segment of the vertebrae, the anterior approach is usually the best surgical option, allowing neural decompression, stabilization and restoration of anatomical spinal alignment. Nevertheless, it represents a big challenge for the spinal surgeon for the presence of important anatomical structures of the upper mediastinum: manubrium, thymus gland, left and right brachiocephalic veins (or innominate veins), right brachiocephalic artery, left common carotid artery, aortic arc, esophagus, trachea and thoracic duct. Varied approaches to the CTJ have been described in literature [low lateral anterior cervical approach (LACA), full sternotomy, lateral parascapular thoracotomy, clavicular dissection]. Among them, the low LACA combined with manubriotomy is the most used and safe (1).