Anatomic considerations of a modified anterior approach to the cervicothoracic junction.

The results of a study on 30 adult human cadavers showed that the anterior aspect of T-3 can be easily exposed through a modified anterior approach to the cervicothoracic spinal junction. Anterior exposure of T-4 caused significant tension on the brachiocephalic vein in 57%; in 7% the vein actually tore. The location of the vital structures is as follows: the left brachiocephalic vein is at T-1 and T-2 in 80%; the aortic arch is at T-2 and T-3 in 90%; the right recurrent laryngeal nerve reaches the tracheoesophageal groove at the level of C-6 in 50%; the thoracic duct empties into the systemic venous system from C-7 to T-2. Adequate exposure of the low cervical to the upper thoracic spine can be obtained with this approach. Preoperative computed tomographic evaluation of the location of the left brachiocephalic vein with respect to the vertebral levels is recommended.