Anterior exposure of the cervicothoracic spine using a combined cervical and thoracic approach.

Anterior stabilization of severe structural deformities of the spine, especially kyphoscoliosis, at the cervicothoracic level is a difficult surgical procedure. A new combined procedure including anterolateral cervical and posterior transpleural transthoracic approaches to the cervicothoracic spine provided adequate-exposure from the third cervical to the ninth thoracic vertebra and at the same time gave access to the great vessels in the event that control of these became necessary. The procedure has been employed in six patients with severe cervicothoracic kyphoscoliosis. Despite the magnitude of the combined cervical and transthoracic exposure, the patients withstood the procedure well and there were no complications. The fusion was successful in all six patients. The kyphotic deformities were corrected by an average of 26 degrees and the scoliotic curves, by an average of 17 degrees.