Surgical Approaches To the Lesions of the Cervicothoracic Junction With Spinal Canal Compromise

Abstract

Aim: Surgical access to cervicothoracic junction pathologies is one of the most common problems in spinal surgery. The surgical approaches to this region have been traditionally divided into anterior and posterior approaches. Posterior approaches such as laminectomy are applied frequently and are well known by all neurosurgeons. However, this approach provides poor exposure to the anterior vertebral elements. Accessing to ventral pathologies thorough laminectomy may be difficult. Material and Method: Between 1994 and 2005, 39 patients having pathologies in cervicothoracic junction were operated on by using anterior and posterior approaches in Neurosurgical department of Ankara University. Result: In 38 patients with neurological deficit, 21 patient were applied anterior and anterolateral approaches, posterolateral approach in 3 patients and posterior approach such as laminectomy in 14 patients. A patient without neurological deficit underwent combined (anterior and posterior) approach. Discussion: The patients undergoing solely laminectomy, progressive deformity developed and their neurologic conditions were deteriorated while the results suggest that anterior approaches improved the quality of life considerably in patients with spinal lesions by restoring or preserving ambulation and by controlling intractable spinal pain with acceptable rates of morbidity and mortality. However, appropriate choice of surgical approach depends on the location of the pathologic process.