Anterior approach to the cervicothoracic junction: an anatomic dissection.

The anterior surgical approach to the cervicothoracic spine presents a challenge to the spine surgeon. To adequately explore the anterior spine from C4 to T4 requires a midsternotomy with extended anterior cervical incision. This approach most adequately provides the extensive cranial-caudal exposure required in dealing with tumors at the cervicothoracic junction. Our surgical experience with five patients harboring tumors in this area of the spine has led us to reflect on the anatomy of the exposure and the corridors of approach at various levels of the cervicothoracic junction. Cadaver dissection and demonstration of the anatomic structures encountered in this exposure and the spinal subdivisions created by these various neurovascular structures will be presented. The anatomy, so demonstrated, will be correlated with the clinical cases.