ABSTRACT
The aim of the present study was to improve the feasibility of anterior decompression and stabilization of the cervico-thoracic junction with transmanubrial transclavicular approach and also to study the problems encountered in anterior reconstruction of the cervico-thoracic junction [CTJ]. Nine patients [mean age 32 +/- 7.33, range 13-60 years; mean duration of symptoms 6.06 +/- 3.07, range 1.5 -12 months; male to female ratio of 4:5] of various pathologies involving the CTJ who were operated by transmanubrial transclavicular approach were analyzed. Preoperative disability was scored using Harsh myelopathic grading system. Eight cases belonged to grade 3 and 4, one to grade 1. On radiology there was mean involvement of 2.2 +/- 0.97 vertebral levels [range 1 - 4]. Eight patients were operated from the left side with an average decompression of 2.11 +/- 0.93 [range 1 - 4] vertebral bodies. Clavicular graft was used in 8 .patients and iliac tricorticate graft in one with plating [instrumentation] done in 8 cases. All the patients showed improvement in immediate postoperative period with significant improvements in their Harsh grades and no major complication. The mean follow-up duration was 9.22 +/- 4.60 [range 1-16 months]. Transmanubrial transclavicular approach provides an excellent exposure of vertebrae and paravertebral spaces of CTJ [lower 2 cervical and upper 2 thoracic vertebrae] allowing anterior spinal cord decompression, grafting and instrumentation without any increase in morbidity and mortality as compared to the conventional approaches