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Anterior approach to the cervicothoracic junction: proposed indication for manubriotomy based on preoperative computed tomography findings.

OBJECTIVE
The purpose of this study was to present straightforward preoperative methods to define the need for manubriotomy in the anterior surgical approach to the cervicothoracic junction.


METHODS
Preoperative MR imaging and CT scanning studies were performed in all patients. The CT images with sagittal reconstructions including the manubrium were done to apply the so-called surgeons' view line. This line is parallel to the inferior plateau of the superior healthy vertebrae or the vertebrae above the herniated intervertebral disc, and the decision concerning the need for manubriotomy depends on the correlation between this line and the manubrium.


RESULTS
Preoperative planning of the need for manubriotomy was correct in all cases. Manubriotomy was never performed in C-7 corpectomy or C7-T1 discectomy cases; nevertheless, manubriotomy was needed in half of the cases when the T-1 corpectomy was the lowest level to be resected (8 cases), and in 4 cases the lowest level to be approached was T-2. The mean surgical time, bleeding volume, postoperative pain intensity, and length of hospital stay were less in the cervicotomy than in the manubriotomy group.


CONCLUSIONS
By using the surgeons' view line and its correlation with the manubrium, the need for manubriotomy can be predicted without compromising decompression and reconstruction. The statistical differences observed in the surgical variables between the manubriotomy and cervicotomy cases justified the use of preoperative evaluation of the need for manubriotomy as an aid to surgical planning and to give the patient and family realistic expectations about the surgery.