Pre-oprative planning for optimal surgical approach in reconstructions of cervicothoracic junction

The surgical management of patients with injuries of the cervicothoracic junction is a challenging issue and the choice of surgical approach for these surgeries is debatable now. This is due to the technical difficulty of the approach conditioned by the topographic anatomy of this area and the severity of possible associated complications. The pre-operative analysis of computer tomography images enables evaluating individual features and planning an optimal approach to the cervicothoracic junction for each patient. However, the numerous methods of pre-operative planning reported in the papers still have certain limitations when used for patients with spine traumas. We suggest a planning option that involves measuring of sternocervical angle formed by the line perpendicular to C7 lower endplate and the line running from the middle of C7 lower endplate to the presternum. We analyzed the database of computer tomography images to find normal and threshold values of sternocervical angle for evaluating the feasibility of the anterior approach to С7, Th1, and Th2 avoiding manubriotomy or sternotomy. It is worth evaluating the sternocervical angle in pre-operative sagittal images when planning the anterior approach to the cervicothoracic junction in clinical practice.